1
|
Nakanishi K, Toyoshima M, Ichikawa G, Suzuki S. Zinc deficiency is associated with gynecologic cancer recurrence. Front Oncol 2022; 12:1025060. [PMID: 36505858 PMCID: PMC9729934 DOI: 10.3389/fonc.2022.1025060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Zinc deficiency can cause various symptoms, including hair loss, anemia, and taste disorders. Recently, the association between cancer and zinc deficiency has received much attention with respect to its antioxidant properties. However, only a few studies have investigated the association between gynecologic cancers and zinc; to date, no studies have evaluated serum zinc status at the onset of gynecologic cancer or the relationship between zinc and cancer recurrence. The objectives of the present study were to determine whether serum zinc concentrations are associated with the development of gynecologic cancer, to clarify serum zinc dynamics between the onset and recurrence of gynecologic cancer, and to identify the associated factors. Accordingly, we retrospectively determined serum zinc concentrations before treatment in gynecologic patients with benign disease or cancer at the Nippon Medical School Chiba Hokusoh Hospital. We investigated anemia and hypoalbuminemia-the most common causes of zinc deficiency-as indicators of hyponutrition to determine the causal relationship of this deficiency with chemotherapy, radiation therapy, and recurrence, which may affect zinc concentration during cancer recurrence. The results indicated that there was no difference in zinc concentration between preoperative cancer patients and noncancer patients and that serum zinc concentrations were not associated with developing gynecologic cancers. However, patients with gynecologic cancer exhibited significantly lower serum zinc concentrations following treatment, and patients with recurrent cancer were 4.8 times more likely to develop zinc deficiency than those with nonrecurrent cancer. A serum zinc concentration of <61 μg/dL was an independent predictor of recurrence. Once zinc deficiency occurred, the recurrence rate of zinc deficiency reached as high as 69%. Overall, our study indicates that zinc deficiency is associated with recurrence in gynecological cancers and physicians should monitor zinc levels during disease management.
Collapse
Affiliation(s)
- Kazuho Nakanishi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan,*Correspondence: Kazuho Nakanishi,
| | - Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Go Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
2
|
Sato E, Sato S, Degawa M, Ono T, Lu H, Matsumura D, Nomura M, Moriyama N, Amaha M, Nakamura T. Effects of Zinc Acetate Hydrate Supplementation on Renal Anemia with Hypozincemia in Hemodialysis Patients. Toxins (Basel) 2022; 14:toxins14110746. [PMID: 36355996 PMCID: PMC9692580 DOI: 10.3390/toxins14110746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION AND AIMS This study examined whether zinc supplementation with zinc acetate hydrate improved renal anemia with hypozincemia in patients undergoing hemodialysis. METHODS The study participants included 21 patients undergoing hemodialysis who presented with a serum zinc level < 60 mg/dL and who were administered zinc acetate hydrate at 50 mg (reduced to 25 mg, as appropriate) for 6 months. Patients with a hemorrhagic lesion, acute-phase disease (pneumonia or cardiac failure), or hematologic disease and those whose treatment was switched from peritoneal dialysis to hemodialysis were excluded. The changes in the erythropoietin resistance index (ERI) before and after zinc acetate hydrate administration were examined. ERI was defined as the dose (IU) of erythropoiesis-stimulating agent (ESA)/week/body weight (kg)/hemoglobin content (g/dL). The differences between the two groups were analyzed using the Wilcoxon signed rank sum test, and p < 0.05 was considered statistically significant. RESULTS The study participants included 19 men and 2 women aged 41-95 years (mean ± standard deviation (SD): 67.1 ± 13.6). The changes in the values of parameters measured before and after zinc acetate hydrate administration were as follows: Blood Hb did not change significantly, from 10.0-13.6 g/dL (11.5 ± 1.0 g/dL) to 10.2-12.4 g/dL (11.4 ± 0.7 g/dL); serum zinc concentration significantly increased, from 33.0-59.0 mg/dL μg/dL (52.4 ± 7.6 mg/dL μg/dL) to 57.0-124.0 mg/dL μg/dL (84.1 ± 16.3 mg/dL μg/dL; p < 0.01); the ESA dose significantly decreased, from 0-12,000 IU/week (5630 ± 3351 IU/week) to 0-9000 IU/week (4428 ± 2779; p = 0.04); and ERI significantly decreased, from 0.0-18.2 (8.1 ± 5.1) to 0.0-16.0 (6.3 ± 4.3; p = 0.04). CONCLUSIONS Zinc supplementation increased the serum zinc concentration and significantly reduced the ESA dose and ERI, suggesting that a correction of hypozincemia contributes to lessening renal anemia in these patients.
Collapse
Affiliation(s)
- Eiichi Sato
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo 270-0034, Japan
- Correspondence:
| | - Shohei Sato
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo 270-0034, Japan
| | - Manaka Degawa
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo 270-0034, Japan
| | - Takao Ono
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo 270-0034, Japan
| | - Hongmei Lu
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo 270-0034, Japan
| | - Daisuke Matsumura
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo 270-0034, Japan
| | - Mayumi Nomura
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo 270-0034, Japan
| | - Noriaki Moriyama
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo 270-0034, Japan
| | - Mayuko Amaha
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo 270-0034, Japan
| | - Tsukasa Nakamura
- Department of Nephrology, Kashiwa Forest Clinic Kashiwa, Kashiwa 277-0042, Japan
| |
Collapse
|
3
|
Uchida Y, Uemura H, Tsuji S, Yamada S, Kouyama JI, Naiki K, Sugawara K, Nakao M, Nakayama N, Imai Y, Tomiya T, Mochida S. Significance of furosemide in patients with cirrhosis treated with or without zinc acetate hydrate supplementation. Hepatol Res 2022; 52:449-461. [PMID: 35113468 DOI: 10.1111/hepr.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Japanese guidelines for the treatment of cirrhosis suggest zinc supplementation to prevent hepatic encephalopathy in patients with cirrhosis and zinc deficiency, although the factors that are associated with therapeutic efficacy remain unknown. METHOD A total of 159 patients with chronic liver diseases but without previous zinc supplementation were analyzed. Factors associated with serum zinc levels as well as the therapeutic efficacy of zinc supplementation were evaluated. RESULT Serum zinc levels decreased with the progression of liver diseases. A multiple linear regression analysis revealed that the serum levels of albumin and cholinesterase and the daily furosemide dose were independently associated with the serum zinc levels. The optimal furosemide cut-off dosage for patients with zinc deficiency (<60 μg/dl) was 5 mg/day. Among 34 patients receiving zinc acetate hydrate, overt hepatic encephalopathy occurred in 12 patients (35.4%). A multivariate analysis identified a minimal serum zinc level of 50 μg/dl after more than 12 weeks of zinc supplementation as a factor associated with overt encephalopathy development, while furosemide use was not associated. The Child-Pugh score at baseline was the only factor associated with the maintenance of sufficient serum zinc levels. CONCLUSION Although the furosemide dose was negatively correlated with the serum zinc level in patients with chronic liver diseases, furosemide use was not associated with the occurrence of overt encephalopathy in those receiving zinc supplementation. Serum zinc levels of ≥50 μg/dl were required to prevent overt encephalopathy development during zinc supplementation in both patients with and those without furosemide administration.
Collapse
Affiliation(s)
- Yoshihito Uchida
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Hayato Uemura
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Shohei Tsuji
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Shunsuke Yamada
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Jun-Ichi Kouyama
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Kayoko Naiki
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Kayoko Sugawara
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Masamitsu Nakao
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Nobuaki Nakayama
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Yukinori Imai
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Tomoaki Tomiya
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Satoshi Mochida
- Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| |
Collapse
|
4
|
Ozeki I, Nakajima T, Suii H, Tatsumi R, Yamaguchi M, Arakawa T, Kuwata Y, Toyota J, Karino Y. Evaluation of treatment with zinc acetate hydrate in patients with liver cirrhosis complicated by zinc deficiency. Hepatol Res 2020; 50:488-501. [PMID: 31729098 DOI: 10.1111/hepr.13461] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
AIM In Japan, no zinc preparation had been approved for therapeutic purposes before March 2017. Zinc acetate hydrate was recently approved for the treatment of hypozincemia. We evaluated the efficacy and safety of treatment with zinc acetate hydrate. METHODS A total of 97 patients with cirrhosis complicated by hypozincemia were treated with zinc acetate hydrate, and their serum zinc normalization rates; factors contributing to normalization; changes in blood ammonia levels; branched-chain amino acids-to-tyrosine ratios; levels of albumin, hemoglobin, alkaline phosphatase, serum copper, and iron; incidence of adverse events; improvement in subjective symptoms; and serum zinc levels taken at 3 months post-treatment were determined. RESULTS The cumulative serum zinc normalization rates, when normalization was defined as achievement of a serum zinc level ≥80 μg/dL, after 2, 4, and 6 months of treatment were 64.9%, 80.3%, and 82.5%, respectively. Multivariate analysis identified an albumin level of ≥3.3 g/dL and branched-chain amino acids to tyrosine ratio of ≥3.46 as factors contributing to zinc normalization within 3 months of treatment. Treatment resulted in a significant decrease in blood ammonia and serum copper levels, and significant increases in branched-chain amino acids-to-tyrosine ratios and alkaline phosphatase levels. Seven (7.2%) patients prematurely discontinued treatment due to hypocupremia. By the end of treatment, subjective symptoms had resolved in 46.2% of patients. By 3 months post-treatment, serum zinc levels had reverted to levels close to those at baseline. CONCLUSIONS Treatment with zinc acetate hydrate resulted in normalization of serum zinc levels at a high rate. The main reasons for discontinuation of treatment included hypocupremia.
Collapse
|
5
|
Okamoto T, Hatakeyama S, Konishi S, Okita K, Tanaka Y, Imanishi K, Takashima T, Saitoh F, Suzuki T, Ohyama C. Comparison of zinc acetate hydrate and polaprezinc for zinc deficiency in patients on maintenance hemodialysis: A single-center, open-label, prospective randomized study. Ther Apher Dial 2019; 24:568-577. [PMID: 31794152 DOI: 10.1111/1744-9987.13461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/30/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
The efficacy and safety of zinc acetate hydrate (ZAH) for zinc supplementation in patients on maintenance hemodialysis (MHD) remains unknown. In this prospective, single-center, open-label, parallel-group trial for MHD patients with serum zinc level <70 μg/dL, we compared ZAH (zinc; 50 mg/day) and polaprezinc (PPZ; zinc; 34 mg/day) beyond 6-month administration in a 1:1 randomization manner. The ZAH and PPZ groups had 44 and 47 patients, respectively. At 3 months, the change rate of serum zinc levels in the ZAH group was significantly higher than that in the PPZ group. Three months after the study, serum copper levels significantly decreased in the ZAH group, but not in the PPZ group. No significant differences were noted in anemia management in either group. ZAH was superior to PPZ in increasing serum zinc levels. Clinicians should note the stronger decline in serum copper levels when using ZAH for MHD patients.
Collapse
Affiliation(s)
- Teppei Okamoto
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, Aomori, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sakae Konishi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazutaka Okita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshimi Tanaka
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, Aomori, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kengo Imanishi
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, Aomori, Japan
| | - Tooru Takashima
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, Aomori, Japan
| | - Fumitada Saitoh
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, Aomori, Japan
| | - Tadashi Suzuki
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|