1
|
Stefanowicz F, Gashut RA, Talwar D, Duncan A, Beulshausen JF, McMillan DC, Kinsella J. Assessment of plasma and red cell trace element concentrations, disease severity, and outcome in patients with critical illness. J Crit Care 2013; 29:214-8. [PMID: 24388658 DOI: 10.1016/j.jcrc.2013.10.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 10/14/2013] [Accepted: 10/20/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of the study is to examine the value of both plasma and red cell trace element measurements when assessing nutritional status in patients with critical illness. MATERIALS AND METHODS A total of 125 patients who were admitted to intensive care unit with evidence of systemic inflammatory response as per Bone's criteria were recruited. Venous blood samples were obtained from all on admission and, in 31 of the 125 patients, on approximately days 4 and 7. Copper, zinc, and selenium concentrations were measured in plasma and erythrocytes and results related to mortality and patient outcome measures. RESULTS A total of 125 critically ill patients were recruited; 81 (66%) were male, the median age was 60 (range, 18-100), and the medical/surgical proportion was 55/70 (44%/56%). The median (lower and upper 2.5th percentile) Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, and length of stay and mortality were 21 (16-26), 7 (4-9) 3.7 days (1.5-11.1) and 19%, respectively. Plasma zinc and selenium concentrations were significantly lower on admission compared with reference intervals, whereas copper was increased. Normal plasma glutathione peroxidase activity suggested selenium status was adequate on admission; erythrocyte concentrations of glutathione peroxidase and trace elements were normal, suggesting adequate nutritional status 1 to 2 months before admission. Only plasma zinc and selenium were inversely associated with C-reactive protein (rs = -0.266, P = .004, rs = -0.322, P < .001, respectively). Compared with survivors, albumin (P < .001) concentrations were significantly lower in the nonsurvivor group. No significant difference of plasma selenium and zinc between survivors and nonsurvivors was found, although plasma selenium concentrations tended to be lower (P = .04). On multivariate logistic regression analysis of the significant variables, none was independently associated with mortality. CONCLUSION The altered plasma concentrations of zinc, selenium, and copper in patients with critical illness were primarily due to the effects of the systemic inflammatory response and do not reliably indicate their status.
Collapse
Affiliation(s)
- Fiona Stefanowicz
- The Scottish Trace Element and Micronutrient Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow G31 2ER, UK
| | - Rawia A Gashut
- Academic Unit of Anaesthesia, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK
| | - Dinesh Talwar
- The Scottish Trace Element and Micronutrient Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow G31 2ER, UK
| | - Andrew Duncan
- The Scottish Trace Element and Micronutrient Reference Laboratory, Department of Biochemistry, Royal Infirmary, Glasgow G31 2ER, UK.
| | - Julia F Beulshausen
- Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences- University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK
| | - Donald C McMillan
- Academic Unit of Anaesthesia, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK
| | - John Kinsella
- Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences- University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK
| |
Collapse
|
2
|
Oakes EJ, Lyon TD, Duncan A, Gray A, Talwar D, O’Reilly DS. Acute inflammatory response does not affect erythrocyte concentrations of copper, zinc and selenium. Clin Nutr 2008; 27:115-20. [DOI: 10.1016/j.clnu.2007.10.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 07/20/2007] [Accepted: 10/10/2007] [Indexed: 10/22/2022]
|
3
|
Abstract
Food systems need to produce enough of the essential trace element Se to provide regular adult intakes of at least 40 μg/d to support the maximal expression of the Se enzymes, and perhaps as much as 300 μg/d to reduce risks of cancer. Deprivation of Se is associated with impairments in antioxidant protection, redox regulation and energy production as consequences of suboptimal expression of one or more of the Se-containing enzymes. These impairments may not cause deficiency signs in the classical sense, but instead contribute to health problems caused by physiological and environmental oxidative stresses and infections. At the same time, supranutritional intakes of Se, i.e. intakes greater than those required for selenocysteine enzyme expression, appear to reduce cancer risk. The lower, nutritional, level is greater than the typical intakes of many people in several parts of the world, and few populations have intakes approaching the latter, supranutritional, level. Accordingly, low Se status is likely to contribute to morbidity and mortality due to infectious as well as chronic diseases, and increasing Se intakes in all parts of the world can be expected to reduce cancer rates.
Collapse
Affiliation(s)
- G F Combs
- Department of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
| |
Collapse
|
4
|
Akobeng AK, Richmond K, Miller V, Thomas AG. Effect of exclusive enteral nutritional treatment on plasma antioxidant concentrations in childhood Crohn's disease. Clin Nutr 2007; 26:51-6. [PMID: 17161887 DOI: 10.1016/j.clnu.2006.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 10/05/2006] [Accepted: 10/17/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Oxidative stress and depletion of antioxidants may play a role in the pathogenesis of Crohn's disease (CD). The aim of this study was to determine the effect of exclusive enteral nutrition, which is increasingly being used as primary therapy for CD, on plasma antioxidant concentrations in children with active CD. METHODS In a double-blind randomised controlled trial, 15 children with active CD (mean age, 11.3 years, range 6.8-15.7) attending a paediatric gastroenterology referral centre, were assigned to receive either a standard polymeric diet (Group S, n=8) or a glutamine-enriched polymeric diet (Group G, n=7) as primary therapy for active CD. Plasma concentrations of selenium, urates, vitamin A, vitamin E, vitamin C, glutathione, and also malondialdehyde (MDA) were measured at baseline and after 4 weeks of exclusive enteral nutritional treatment. RESULTS Mean (95% CI) selenium concentration of the cohort increased significantly from 0.82 micromol/l (0.72, 0.91) to 1.14 micromol/l (0.98, 1.3), P<0.001. There were, however, significant reductions in mean concentrations of vitamin C {11.8 mg/l (7.7, 15.8) to 6.5 mg/l (4.5, 8.7), P=0.01} and vitamin E {11.3 mg/l (10.3, 12.4) to 9.4 mg/l (8.7, 10.1), P=0.03}. The concentrations of vitamin A, urates, glutathione and MDA did not change significantly over the study period. Glutamine supplementation did not have any significant effect on plasma antioxidant concentrations. CONCLUSIONS Significant changes in circulating antioxidant concentrations occurred in children with active CD receiving exclusive enteral nutritional treatment. Glutamine supplementation was not beneficial in improving plasma antioxidant status.
Collapse
Affiliation(s)
- Anthony K Akobeng
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Manchester, UK.
| | | | | | | |
Collapse
|
5
|
Abstract
To clarify the relationship between selenium (Se) deficiency and functional disorders, the authors determined the Se concentration, anti-oxidant enzyme activity, and other parameters in rats fed a Se-deficient diet. Rats fed the Se-deficient diet showed a decrease in Se concentration and glutathione peroxidase (GSH-Px) activity in plasma, erythrocytes, heart, liver, and skeletal muscle from the first week after the initiation of the diet, an increase in heart lipid peroxide concentration from the second week, and an increase in liver glutathione S-transferase activity from the fourth week. From the twelfth week, a decrease in the growth rate in the rats fed the Se-deficient diet was observed. In spite of this growth impairment, no changes in electrocardiogram, muscle tone, degree of hemolysis, plasma biochemistry, or hematological values were detected. In summary, the authors found that a reduction of body Se is easily induced, but that the appearance of functional disorders following Se deficiency is difficult to detect in rats.
Collapse
Affiliation(s)
- A Matsuda
- Infusion Research Department, Hoechst Marion Roussel Ltd. 1658, Shiga, Japan
| | | | | |
Collapse
|
6
|
Matsuda A, Kimura M, Itokawa Y. Influence of selenium deficiency on the acute cardiotoxicity of adriamycin in rats. Biol Trace Elem Res 1997; 57:157-67. [PMID: 9282263 DOI: 10.1007/bf02778199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The influence of selenium (Se) deficiency on the acute cardiotoxicity induced by the anticancer drug adriamycin (ADR) has been studied in rats by electrocardiography. Two categories were formed by feeding groups of rats a Se-supplemented and a Se-deficient diet. The supplemented animals were taken as normals. The two categories were treated with iv injections of saline solution containing ADR at doses of 0, 7.5, and 15 mg/kg body wt. The cardiac Se concentration and glutathione peroxidase (GSH-Px) activity in the Se-deficient groups were < 2% lower than in the normals. The normal groups showed significant widening of the SaT and QaT durations when given 15 mg/kg ADR. The Se-deficient groups exhibited a dose-dependent widening of the SaT and QaT duration at 7.5 and 15 mg/kg and narrowing of the PQ duration at 15 mg/kg ADR. No heart rate or QRS duration changes were detected in both categories. Our results suggest that an imbalance of the antioxidant system is associated with Se deficiency and that Se plays a role in preventing the cardiac functional disorder attributable to oxygen free radical formation induced by ADR.
Collapse
Affiliation(s)
- A Matsuda
- Development Laboratories, Nippon Hoechst Marion Roussel Ltd., Shiga, Japan
| | | | | |
Collapse
|
7
|
Levy JB, Jones HW, Gordon AC. Selenium deficiency, reversible cardiomyopathy and short-term intravenous feeding. Postgrad Med J 1994; 70:235-6. [PMID: 8183763 PMCID: PMC2397862 DOI: 10.1136/pgmj.70.821.235] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report the case of a patient with Crohn's disease receiving short-term postoperative parenteral nutrition supplemented with trace elements who nevertheless became selenium deficient with evidence of a cardiomyopathy. This was fully reversible with oral selenium supplementation. Current parenteral feeding regimes may not contain enough selenium for malnourished patients.
Collapse
Affiliation(s)
- J B Levy
- Department of Geratology, John Radcliffe Hospital, Oxford, UK
| | | | | |
Collapse
|
8
|
Abstract
Short-bowel syndrome is characterized by maldigestion, malabsorption, dehydration, electrolyte abnormalities, and both macronutrient and micronutrient deficiencies. Nutritional and hydration status are difficult to maintain without the provision of specialized nutrition support when more than 75% of the small intestine has been resected. Each patient's response to small-bowel resection is unique; therefore, the type of therapy must be tailored to each individual's bowel resection, complications that ensue, and specific nutrient needs. Clinical management should be guided by principles of nutrition assessment and treatment of nutrient deficiencies as well as routine monitoring of the patient's clinical course and response to therapy.
Collapse
|
9
|
Messing B, Man F, Therond P, Hanh T, Thuillier F, Rambaud JC. Selenium status prior to and during one month total parenteral nutrition in gastroenterological patients: A randomised study of two dosages of Se supplementation. Clin Nutr 1990; 9:281-8. [PMID: 16837371 DOI: 10.1016/0261-5614(90)90037-s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/1989] [Accepted: 01/15/1990] [Indexed: 10/26/2022]
Abstract
13 consecutive adult gastroenterological patients with non-malignant disease who were candidates for total parenteral nutrition (TPN), and who had mild protein-energy malnutrition (82 +/- 3% of ideal body weight, serum albumin 32 +/- 2 g/l, mean +/- SEM) were found to have, prior to TPN, a Selenium level 50% less than controls (p < 0.001) as assayed by Se and glutathione peroxidase (GSHPx) in plasma and erythrocytes. Compared with other trace metals and minerals, eg, Mn, Zn and Cu, depletion of Selenium was the most marked in this population. Patients were randomised to be supplemented with either 100 or 200 microg/d of sodium-selenite, equal to 32 microg (0.4 micromol) or 64 microg (0.8 micromol) of selenium, in two cross-over periods of TPN, each of two weeks. In this short term study, significant increases in the four measurements of Se status (p < 0.05) were seen in all patients, but there was no difference between those receiving the high or low dose of the element. GSHPx in plasma was normalised within 1 month whereas the increase seen in the erythrocyte pool was consistent with a 4-month half-life. Pooled Se values for patients and controls showed logarithmic correlations between Se and GSHPx in erythrocytes (p < 0.001) and plasma (p < 0.01). Changes in GSHPx provided further evidence of Se depletion in our patients. This study suggests that malnourished gastroenterological patients receiving TPN require Se supplements and that 100 microg (0.4 micromol)/d of sodium-selenite is adequate for most patients since there was no additional benefit from the higher dose of 200 microg (0.8 micromol).
Collapse
Affiliation(s)
- B Messing
- Centre Agréé de Nutrition Parentérale à Domicile, Hôpital Saint-Lazare, INSERM U.290, France
| | | | | | | | | | | |
Collapse
|
10
|
Mansell PI, Allison SP, Vardey H, Fell GS, Shenkin A. Clinical effects and adequacy of a new all-in-one dextrose-electrolyte-trace element preparation in patients on prolonged TPN. Clin Nutr 1989; 8:313-9. [PMID: 16837307 DOI: 10.1016/0261-5614(89)90006-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/1988] [Accepted: 04/19/1989] [Indexed: 10/26/2022]
Abstract
We have devised a new all-in-one dextrose/electrolyste/trace element mixture (Polyfusor DY) and tested its efficacy in clinical practice. Polyfusor DY was designed to be combined with an amino-acid preparation and to be infused with lipid in a standard total parenteral nutrition (TPN) regimen. This standard regimen was formulated to provide minimum nitrogen, energy, fluid, electrolyte, vitamin and trace element requirements for the stable patient. The adequacy of currently recommended levels of provision of trace elements was tested in patients receiving long periods of intravenous nutrition. Eleven consecutive patients were fed from 13 to 280 days using TPN prescriptions based on this standard regimen. Two patients died but the nutritional state of the remainder improved. Serum concentrations of zinc, copper, chromium and manganese remained largely within or above the reference ranges, however the selenium content of Polyfusor DY (500 nmol/l) was marginally inadequate to maintain normal biochemistry. Pharmacy compounding time for the standard TPN regimen based on Polyfusor DY was 10.6 +/- 0.19 min (mean +/- SEM) compared with 22.5 +/- 0.30 min for non-standard TPN regimens prescribed independently by other clinicians (P < 0.001). A standard TPN regimen based on Polyfusor DY was clinically effective, in particular giving generally adequate trace element provision with a reduction in pharmacy time and costs.
Collapse
Affiliation(s)
- P I Mansell
- Department of Medicine, University Hospital, Nottingham, UK
| | | | | | | | | |
Collapse
|
11
|
Abstract
A retrospective study of serum selenium determinations performed in a hospital laboratory revealed 47 cases of hyposelenaemia (defined as a serum selenium level below 0.74 mumol l-1). Moderate hyposelenaemia (serum selenium 0.30-0.55 mumol l-1) was found in 11 patients and seven of these suffered from gastrointestinal diseases. Furthermore severe hyposelenaemia (serum selenium below 0.30 mumol l-1) was detected in three patients, who were all affected by gastrointestinal disease. We concluded that patients with gastrointestinal diseases are especially at risk of developing selenium deficiency and should be monitored by repeated determinations of serum selenium. Patients with moderate or severe hyposelenaemia should receive selenium treatment.
Collapse
Affiliation(s)
- B Bjerre
- Department of Internal Medicine and Clinical Chemistry, Faculty of Health Sciences, University of Linköping, Sweden
| | | | | |
Collapse
|
12
|
Abstract
Selenium is an essential trace element in humans and animals. Its only established function in humans is the antioxidant activity of glutathione peroxidase, a selenoenzyme. Severe prolonged deficiency may cause a fatal cardiomyopathy. Iatrogenic causes of selenium deficiency include parenteral and enteral nutrition. Low plasma selenium is also found in malabsorption, cystic fibrosis, rheumatoid arthritis, neoplasia, and other varied clinical disorders. Death has resulted from a single massive ingestion of selenium, while chronic excessive intake causes skin, nail, and hair pathology. Extreme geographical variation in population blood and urine selenium levels and a marked age-specific variation in population reference intervals are important factors in understanding selenium nutrition. Nutritional requirements, biological availability, and metabolism are discussed in relation to geographical, age, and method variability. Sampling, processing procedures, and methods for selenium quantitation are reviewed. Selenium content in different biological matrices and reference values for pediatric, adult, and obstetric populations are provided.
Collapse
Affiliation(s)
- G Lockitch
- Department of Pathology, British Columbia's Children's Hospital, Vancouver, Canada
| |
Collapse
|
13
|
Hinks LJ, Inwards KD, Lloyd B, Clayton B. Reduced concentrations of selenium in mild Crohn's disease. J Clin Pathol 1988; 41:198-201. [PMID: 3350980 PMCID: PMC1141378 DOI: 10.1136/jcp.41.2.198] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The concentrations of selenium, zinc, and copper were determined in whole blood, plasma, and leucocytes in 20 patients with relatively mild Crohn's disease, nine of whom were being treated with steroids, and compared with those of a control group. There was a significant decrease in the concentration of selenium in the leucocytes as well as in whole blood and plasma in the patients. Steroids seemed to affect only the concentrations of zinc and copper in plasma. The concentrations of copper and zinc in whole blood, plasma, and leucocytes in patients not taking steroids were not significantly different from those of the control group. The observations suggest that those patients with an apparently satisfactory whole body concentration of copper and zinc may still be at risk of a decrease in the body content of selenium.
Collapse
Affiliation(s)
- L J Hinks
- Department of Chemical Pathology and Human Metabolism, Faculty of Medicine, University of Southampton, Southampton General Hospital
| | | | | | | |
Collapse
|
14
|
Abstract
Presently there are no specific laboratory tests to diagnose inflammatory bowel disease (IBD). Nonspecific tests to differentiate diarrhea due to mucosal injury from that occurring in patients with normal bowel mucosa (eg, fecal occult blood, leukocytes, etc) are not helpful. Tests to exclude infections agents are very important, since the clinical and radiological appearance of these may mimic IBD, and patients with IBD may suffer from superinfection. There are no laboratory tests which can differentiate Crohn's colitis from ulcerative colitis (UC). The tests used in the assessment and management of severely ill patients (Hgb, WBC, electrolytes, etc) are important, since abnormalities need to be corrected on an ongoing basis. The tests used to assess nutritional status are of little clinical value, since "clinical assessment" is as good as the laboratory assessment. Estimation of disease activity by tests is rarely better than the judgment of the clinician. Workup for malabsorption in Crohn's disease and the assessment of absorptive capacity of the terminal ileum are important for proper planning of management. Laboratory tests are also useful in clarifying the nature of some complications (eg, anemias and joint diseases).
Collapse
Affiliation(s)
- I T Beck
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
15
|
Hesselvik F, Carlsson C, von Schenck H, Sörbo B. Low selenium plasma levels in surgical and intensive care patients: Relation to infection. Clin Nutr 1987. [DOI: 10.1016/0261-5614(87)90044-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
16
|
Reversal of a skeletal myopathy with selenium supplementation in a patient on home parenteral nutrition. Clin Nutr 1987. [DOI: 10.1016/0261-5614(87)90054-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
17
|
Mirtallo JM, Oh T. A key to the literature of total parenteral nutrition: update 1987. DRUG INTELLIGENCE & CLINICAL PHARMACY 1987; 21:594-606. [PMID: 3111809 DOI: 10.1177/1060028087021007-805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This comprehensive bibliography is intended to enhance the education of the practitioner, student, and academician in the area of parenteral nutrition. This bibliography is not all-inclusive but serves as an update from the original published in 1983. Of particular note in this work is the addition of topics that reflect a growing interest in medical specialties with regard to patient nutritional status and support.
Collapse
|
18
|
Boosalis MG, Solem LD, Ahrenholz DH, McCall JT, McClain CJ. Serum and urinary selenium levels in thermal injury. Burns 1986; 12:236-40. [PMID: 3719397 DOI: 10.1016/0305-4179(86)90122-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Information concerning selenium status in thermal injury patients is limited. Therefore, both serum selenium concentration and 24 h urinary excretion of selenium were evaluated throughout the hospital course for 23 patients with partial and full skin thickness thermal burns. Serum selenium levels were depressed throughout the hospital course in the majority of patients, and only two patients' serum selenium levels had reached the normal range by discharge. Urinary selenium losses were essentially within normal range throughout the same period and thus were not responsible for the observed depression in serum selenium levels. A possible antagonistic relationship between selenium and silver is discussed.
Collapse
|
19
|
Roekens EJ, Robberecht HJ, Deelstra HA. Dietary selenium intake in Belgium for different population groups at risk for deficiency. ZEITSCHRIFT FUR LEBENSMITTEL-UNTERSUCHUNG UND -FORSCHUNG 1986; 182:8-13. [PMID: 3082085 DOI: 10.1007/bf01079883] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
An estimation of the dietary selenium intake in different population groups in Belgium has been carried out. 24 h duplicate meals and food consumption statistics combined with concentration levels in different foods, as determined by hydride generation atomic absorption spectrometry, are used. Dietary intake of selenium is low to very low, especially for vegetarians (12.7 +/- 9.1 micrograms) and patients on long-term total parenteral nutrition (1.2 +/- 0.8 microgram). The different intakes are discussed and compared with intakes published for other countries, while the importance of bioavailability of the selenium in food in the risk of deficiency is stressed.
Collapse
|