Multivariate analysis of the selected metals in the hair of cerebral palsy patients versus controls

Comparative studies of hair shaft components between healthy and diseased donors

Globally, the rapid aging of the population is predicted to become even more severe in the second half of the 21st century. Thus, it is expected to establish a growing expectation for innovative, non-invasive health indicators and diagnostic methods to support disease prevention, care, and health promotion efforts. In this study, we aimed to establish a new health index and disease diagnosis method by analyzing the minerals and free amino acid components contained in hair shaft. We first evaluated the range of these components in healthy humans and then conducted a comparative analysis of these components in subjects with diabetes, hypertension, androgenetic alopecia, major depressive disorder, Alzheimer's disease, and stroke. In the statistical analysis, we first used a student's t test to compare the hair components of healthy people and those of patients with various diseases. However, many minerals and free amino acids showed significant differences in all diseases, because the sample size of the healthy group was very large compared to the sample size of the disease group. Therefore, we attempted a comparative analysis based on effect size, which is not affected by differences in sample size. As a result, we were able to narrow down the minerals and free amino acids for all diseases compared to t test analysis. For diabetes, the t test narrowed down the minerals to 15, whereas the effect size measurement narrowed it down to 3 (Cr, Mn, and Hg). For free amino acids, the t test narrowed it down to 15 minerals. By measuring the effect size, we were able to narrow it down to 7 (Gly, His, Lys, Pro, Ser, Thr, and Val). It is also possible to narrow down the minerals and free amino acids in other diseases, and to identify potential health indicators and disease-related components by using effect size.

Association between Cu/Zn/Iron/Ca/Mg levels and cerebral palsy: a pooled-analysis

It was well documented that macro/trace elements were associated with the neurodevelopment. We aimed to investigate the relationship between copper (Cu)/zinc (Zn)/iron/calcium (Ca)/magnesium (Mg) levels and cerebral palsy (CP) by performing a meta-analysis. We searched the PubMed, Embase, Cochrane and Chinese WanFang databases from January 1985 to June 2022 to yield studies that met our predefined criteria. Standard mean differences (SMDs) of Cu/Zn/Iron/Ca/Mg levels between CP cases and healthy controls were calculated using the fixed-effects model or the random-effects model, in the presence of heterogeneity. 95% confidence intervals (CI) were also computed. Sensitivity analysis was performed by omitting each study in turn. A total of 19 studies were involved in our investigation. CP cases showed markedly lower Cu, Zn, iron and Ca levels than those in controls among overall populations (SMD =  - 2.156, 95% CI - 3.013 to - 1.299, P < 10-4; SMD =  - 2.223, 95% CI - 2.966 to - 1.480, P < 10-4; SMD =  - 1.092, 95% CI - 1.513 to - 0.672, P < 10-4; SMD =  - 0.757, 95% CI - 1.475 to - 0.040, P = 0.038) and Asians (SMD =  - 2.893, 95% CI - 3.977 to - 1.809, P < 10-4; SMD =  - 2.559, 95% CI - 3.436 to - 1.683, P < 10-4; SMD =  - 1.336, 95% CI - 1.807 to - 0.865, P < 10-4; SMD =  - 1.000, 95% CI - 1.950 to - 0.051, P = 0.039). CP cases showed markedly lower Zn level than that in controls among Caucasians (SMD =  - 0.462, 95% CI - 0.650 to - 0.274, P < 10-4). No significant differences of Cu, iron and Ca levels between CP cases and controls among Caucasians (SMD =  - 0.188, 95% CI - 0.412 to 0.037, P = 0.101; SMD =  - 0.004, 95% CI - 0.190 to 0.182, P = 0.968; SMD = 0.070, 95% CI - 0.116 to 0.257, P = 0.459) were observed. No marked difference of Mg level between CP cases and controls was noted among overall populations (SMD =  - 0.139, 95% CI - 0.504 to 0.226, P = 0.455), Asians (SMD =  - 0.131, 95% CI - 0.663 to 0.401, P = 0.629), and Caucasians (SMD =  - 0.074, 95% CI - 0.361 to 0.213, P = 0.614). Sensitivity analysis did not change the overall results significantly for Cu, Zn, iron and Mg. CP cases demonstrated significantly lower levels of Cu/Zn/iron/Ca than those in healthy controls, particularly in Asians. Decreasing trend of Cu/Zn/iron/Ca levels merit attention, particularly in the population with high susceptibility to CP. Frequent monitoring and early intervention may be needed.

Evaluation of micronutrient levels in children with cerebral palsy

BACKGROUND

Many studies evaluating the nutritional status of children with cerebral palsy (CP) have focused on energy requirements and protein intake. The present work aimed to assess nutritional status and micronutrient levels of children with (CP).

METHODS

This multicenter, cross-sectional and observational study was conducted in 10 different cities in Turkey. Data were available for 398 participants. Anthropometric measurements, feeding mode, nutritional status, and micronutrient levels were evaluated.

RESULTS

The study was conducted with 398 participants (303 patients and 95 healthy controls). Statistical analysis showed that according to the Gomez Classification, weight-for-age (WFA) revealed malnutrition in 92.6% of children with CP, based on Centers for Disease Control and Prevention percentiles. Measurements of micronutrient levels showed that zinc levels were low in patients, whereas vitamin A levels were low in controls. Phosphorous and manganese levels were significantly lower in malnourished children than in typical children. The results revealed that children consuming enteral nutrition solutions had higher selenium and lower zinc levels than non-consumers.

CONCLUSIONS

Malnutrition is not only a protein- or calorie-based problem; micronutrient deficiencies might cause severe health problems. Children with chronic neurological disabilities must be carefully evaluated for these issues. Therefore, nutritional interventions should be adapted to nutrition.

A Case-Control Study of Essential and Toxic Trace Elements and Minerals in Hair of 0-4-Year-Old Children with Cerebral Palsy

The objective of the present study was to assess hair essential and toxic trace elements and minerals in children with cerebral palsy in relation to age of the examinees. A total of 70 children with cerebral palsy and 70 healthy controls aged 0-4 years old were enrolled in the present study. The examined children were also divided into two age groups of those younger and older than 2 years old. Hair trace element content was assessed using ICP-MS at NexION 300D (PerkinElmer, USA). The obtained data demonstrate that hair boron was more than 2-fold lower in CP children as compared with the control group. At the same time, hair Na, Se, and V levels were 21%, 12%, and 20% lower when compared with healthy controls, respectively. It is also notable that a 9% and 28% decrease in hair Fe and Li levels respectively were nearly significant. The observed alterations were more profound in a younger group of patients. No significant group difference in hair toxic metal and metalloid levels was observed between the general cohorts of children with and without CP. In regression models, only hair Al and Ca contents were significantly associated with the presence of cerebral palsy, whereas hair Mg, Na, Ni, and Se levels were characterized as significant negative predictors. The observed alteration in trace element metabolism may also provide an additional link between cerebral palsy, psychomotor delay, and certain diseases, including diabetes, epilepsy, and osteoporosis. However, further studies using other substrates (blood, urine) or biomarkers are required.

A meta-analysis of zinc levels in breast cancer

BACKGROUND

Breast cancer is the most commonly occurring neoplasm in females, comprising 16% of all female cancers worldwide. Various studies indicate some discrepancies regarding zinc (Zn) levels in various samples of breast cancer patients.

OBJECTIVE

The present study evaluated by meta-analysed the published data for Zn levels analyzed in breast tissue, plasma, serum, and hair samples and its relationship with breast cancer.

METHODS

The present meta-analysis included 36 studies, all of which were published in the years between 1984 to 2017 and selected by searching the databases MEDLINE, EMBASE, Cochrane Library, PubMed, Scopus, and the ISI Web of Knowledge. The articles were analyzed, and I² statistics were used to examine heterogeneity. The objective analysis was performed on data from the 36 studies, with total 1699 study subjects and 2009 controls.

RESULTS

Significant statistical differences overall were observed, based on a random effects model (SMD (95 % CI), -0.78[-1.40, -0.16], P = 0.014). Data from 19 of these studies indicated significant statistical differences between cancerous patients and controls with regard to serum and plasma Zn concentration (SMD [(95 %CI): -1.61(-2.43, -0.79)]. There was a significant statistical difference between the breast tissue and hair as regards Zn status (SMD (95%CI): 2.32(1.42, 3.21)) and (SMD (95v%CI): -1.80(-3.41, -0.20), respectively. Zn concentration levels typically decreased in blood and hair samples of patients with breast cancer, whereas it was elevated in tumor tissues.

CONCLUSIONS

There is a significant relationship between lowered serum Zn concentrations and risk of breast cancer onset or recurrences in women, but because of high heterogeneity, we recommend other primary studies.

Gender as a key factor in trace metal and metalloid content of human scalp hair. A multi-site study

This multi-site study discusses the content of metals and metalloids (MM) in scalp hair of children, living in different environmental contexts, with the purpose of verifying if hair level of some MM is distinctively gender-specific. A total of 943 hair samples (537 females and 406 males) from adolescents were analyzed for their content of Al, As, Ba, Cd, Co, Cr, Cu, Li, Mn, Mo, Ni, Pb, Rb, Sb, Se, Sr, U, V and Zn. Elemental quantification was performed by ICP-MS. The obtained data identified different metal distributions in adolescent girls which exhibited significantly higher hair concentrations of some trace metals, especially Sr, Zn and Ni, than boys. On the base of the median value, hair of female donors contained 3.8 times more Sr (6.6μg/g) than males (1.7μg/g). Highest concentrations of Zn in females were observed in samples from the mining area of Sardinia (587μg/g). Nickel showed significant differences resulting 2.5-fold higher in female hair. Regardless of the residence site, these elements resulted always significantly different (at p<0.01) between female and male indicating that gender is a confounding factor that has to be more extensively considered for a correct interpretation of metal profiles in human hair.

Levels of five metals in male hair from urban and rural areas of Chongqing, China

Heavy metals were measured by flame atomic absorption in male hair from residents in urban and rural areas in Chongqing. The median values of the Cd, Cu, Ni, Pb and Zn were 2.90, 23.9, 9.31, 39.3 and 203 μg/g in urban areas and 0.84, 13.4, 5.56, 14.5 and 169 μg/g in rural area, respectively. The levels of Cd, Ni and Pb both in urban and rural areas lie at the high end of the worldwide figures. The differences in heavy metal distribution pattern indicated that there were more sources of Cd and Pb in urban areas. The levels of Cd were increasing along with the growth of age except for the aged people in urban areas, and no significant relationship was observed between the levels of the heavy metal and the age. It is noticed that the hair of smokers exhibited more heavy metal levels than that of non-smokers both in urban and rural areas. In addition, the hair metal levels of the smokers and non-smokers in urban areas were significantly higher than those in rural area, respectively. Significant pairwise correlations (p < 0.01) were observed among Cd, Cu, Ni and Pb in rural area and only between Cu and Ni and between Pb and Ni in urban areas, indicating the elements in these two areas might originate from different sources. The elevated levels of Cd, Pb and Ni implied that the residents both in urban and rural areas might be at high risk of toxic metal exposure, especially for the children.

Essential metals profile of the hair and nails of patients with laryngeal cancer

Trace elements have an impact on numerous physiological processes. The monitoring of their levels in the organism allows you to detect not only their deficiencies, but also several illnesses. The aim of this study was to compare the levels of essential elements (calcium, magnesium, zinc, copper, iron, manganese) in hair, nails and serum of both patients with laryngeal cancer and healthy people. The determination of six metals was performed by an inductively coupled plasma mass spectrometry (ICP-MS) and an inductively coupled plasma optical emission spectrometry (ICP-OES). The concentration of essential elements in hair and nails of the control group was statistically significantly higher than in the group of patients with laryngeal cancer. In the case of serum, differences were found between the patients and controls in respect of the level of three metals. The results of principal component analysis (PCA) revealed the strong and similar clustering behavior of essential elements in hair and nails. The metals did not correlate between two alternative materials. The present study indicated that, using the level of essential elements in hair and nails as a basis, it is possible to distinguish cancer patients from healthy people. The alternative materials are independent of homeostasis and therefore seem to be more useful in the detection of diseases and mineral deficiencies in human than the classical biological materials, such as blood.

Hair analysis in health assessment

BACKGROUND

Hair analysis is used for estimation of the nutritional status of individuals. In the present work, a systematic review on the relation between the mineral composition of hair and the physical or mental disorders is discussed. Detailed information of examined populations, methods of sample preparations and analytical techniques are presented.

METHODS

A systematic literature search in four electronic databases Scopus, PubMed, Web of Science and Medline (from 1997 to 2012/01/31) for English language articles was performed. In addition, a reference list and manual search was undertaken.

RESULTS

The following number of studies was included: 66. Most of the authors reported that there exists a correlation between deficiency or excess of some elements in hair and occurrence of some diseases, such as: autism, cancer, hypertension, myocardial infarction, kidney disease and diabetes mellitus. However, not all results were consistent.

CONCLUSIONS

Most of the authors concluded that the profile of hair mineral imbalance might be useful as a diagnostic tool for the early diagnosis of many diseases. However, it seems that there is a need to standardize sample preparation procedures, in particular washing and mineralization methods.

Trace elements in scalp hair of children living in differing environmental contexts in Sicily (Italy)

We present here data about trace elements in human scalp hair samples to test whether they are valuable to reflect environmental exposure and contamination by trace elements. The study compares contents of trace elements in scalp hair from a total of 336 children, aged 11-13 years old, living in various geographical areas of Sicily (southern Italy) characterized by differing environmental conditions. Nineteen elements (Al, As, Ba, Cd, Co, Cr, Cu, Li, Mn, Mo, Ni, Pb, Rb, Sb, Se, Sr, U, V and Zn) were determined by inductively coupled plasma mass spectrometry (ICP-MS). Coverage intervals (CI) formulated by the elemental composition of hair samples from the Palermo subjects were compared with the median content of hair from children living in the other study areas. Statistical analysis showed that Al, Ba, Sr and Zn concentrations differed significantly between gender, higher concentrations being observed in girls' hair. Children living close to the volcanic area had higher concentrations of As, Cr, Mn, Ni, Rb, Sb, U, V and Zn. Those living in an area with several old quarries had higher levels of Al, As, Pb, Rb and U. The hair of children living near the Pace del Mela industrial area contained higher levels of As, Ba, Mn, Pb, Rb, Sr and U. Linear discriminant analysis (LDA) between Palermo and the other sites allowed to better assess which variables contribute towards differentiating the groups. Our observations suggest that human hair can be used to monitor exposure to several metals, provided that sampling and analytical procedures, together with statistical treatment of data, are carried out according to standardized protocols.

Comparative assessment of essential and toxic metals in the blood of rheumatoid arthritis patients and healthy subjects

The present study deals with the comparative evaluation of essential and toxic metals in rheumatoid arthritis and healthy donors. Blood samples collected from rheumatoid arthritis patients and healthy subjects were analysed for selected essential and toxic metals (Ca, Mg, Fe, Zn, Cu, Co, Mn, Cr, Cd and Pb). The samples were digested in nitric acid and perchloric acid mixture, followed by quantification of the metals using atomic absorption spectrometry. Mean levels of Ca, Mg, Fe and Zn were significantly higher in the blood of healthy donors; however, elevated levels of Cd, Co, Cr, Cu and Pb were observed in blood of the patients. The correlation coefficients among the selected metals in the blood of arthritis patients were significantly different compared with the healthy counterparts. Multivariate cluster analysis revealed mutual apportionment of the essential and toxic metals in blood of the patients, whereas, in controls, the essential and toxic metals revealed diverse apportionment. Variations in the metal levels with gender, residence and smoking habits were also evaluated in both donor groups. Relative distribution, correlation and apportionment of the essential and toxic metals in the blood of the patients were significantly different than of controls.

Quantitative analysis of toxic and essential elements in human hair. Clinical validity of results

Over the last three decades, there has been an increasing awareness of environmental and occupational exposures to toxic or potentially toxic trace elements. The evolution of biological monitoring includes knowledge of kinetics of toxic and/or essential elements and adverse health effects related to their exposure. The debate whether a hair is a valid sample for biomonitoring or not is still attracting the attention of analysts, health care professionals, and environmentalists. Although researchers have found many correlations of essential elements to diseases, metabolic disorders, environmental exposures, and nutritional status, opponents of the concept of hair analysis object that hair samples are unreliable due to the influence of external factors. This review discusses validity of hair as a sample for biomonitoring of essential and toxic elements, with emphasis on pre-analytical, analytical, and post-analytical factors influencing results.

Reference values for hair minerals of Polish students

In the present work, reference values for the content of elements in human hair were elaborated. The population chosen for the study was a group of students in Polish urban area, which served as a representative group of a population of 20 years old individuals living in Europe. The content of 36 elements (essential (B, Ca, Co, Cr, Cu, Fe, K, Mg, Mn, Mo, Na, P, S, Si, Sn, V, Zn), toxic (Al, As, Cd, Hg, Ni, Pb, Sb, Tl) elements and others (Ag, Ba, Bi, Ce, La, Li, Rb, Sr, Ti, Y, Zr)) was determined in hair sampled from 117 subjects. Hair were digested with nitric acid in microwave oven in closed Teflon bombs and underwent multielemental analysis for the content of macroelements by ICP-OES and for micro- and trace elements by ICP-MS. Reference ranges were determined and considered as the values between 10th and 90th percentile. It was assumed that the values of the extreme low and high 10% in the population reflected mineral imbalance. In the population, a group of females and males was distinguished, and also a group of women which tinted their hair was separated. This enabled to point out the differences in hair mineral content between genders and for tinted and non-tinted hair. Statistical significance of differences was found for several elements, for which separate reference values were elaborated. This concerned the following elements: Ba, Ca, Cu, K, La, Mg, Mn, Si, Sr and Ti. In the interpretation of the level of these elements it is necessary to take into consideration both sex and artificial coloring. Also ratios between elements were evaluated - between nutritive (Ca/Mg, Ca/P, Na/K, Zn/Cu) and nutritive vs. toxic (Zn/Cd, Zn/Pb). In this case the differences were detected only for Ca/P ratio. This shows that perhaps in the future, inter-element ratios rather than the absolute levels of elements would be considered for the interpretation of the results of mineral analysis of hair.

Comparison of trace elements in the scalp hair of malignant and benign breast lesions versus healthy women

Trace elements including Al, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, Sb, Sr, and Zn were analyzed in the scalp hair samples of women with malignant breast lesions, women with benign breast lesions, and healthy donors using atomic absorption spectrophotometric method. In the scalp hair of malignant-tumor patients, the highest average concentration was shown by Ca (1,187 microg/g), followed by Na (655 microg/g), Mg (478 microg/g), Zn (391 microg/g), Sr (152 microg/g), Fe (114 microg/g), and K (89.8), while in the case of benign-tumor patients, the average estimated element levels were 1,522, 1,093, 572, 457, 217, 80.4, and 74.7 microg/g, respectively. Most of the elements exhibited non-normal distribution evidenced by large spread, standard error, and skewness values. Mean concentrations of Ca (634 microg/g), Zn (206 microg/g), Mg (162 microg/g), Fe (129 microg/g), and Na (82.1 microg/g) were noteworthy in the scalp hair of healthy women. Average levels of Na, Sr, K, Cd, Co, Pb, Mg, Ca, Zn, Ni, Sb, and Mn were revealed to be significantly higher in the hair of malignant and benign patients compared to the healthy women; however, Fe, Cu, Al, and Cr were not significantly different in the scalp hair of the three groups. The quartile distributions of Ca, Cd, Co, Cr, K, Mg, Mn, Na, Ni, Pb, Sb, and Sr revealed maximum spread in the scalp hair of malignant and benign groups; nevertheless, Al, Cu, Fe, and Zn exhibited almost comparable quartile levels in the three groups. Strong correlation coefficients were found between Fe and Cd, Al and Na, Mn and Sr, Co and Cr, Cd and Cr, Pb and K, Pb and Mn, Cu and Na, and Al and Fe in the scalp hair of malignant-tumor patients, while Fe and K, Cd and Co, Na and Co, and Cr and Pb showed strong correlations in the scalp hair of benign-tumor patients, both of which were significantly different compared with the healthy subjects. Multivariate cluster analysis also revealed divergent clustering of the elements in the scalp hair of malignant and benign patients in comparison with the healthy women.