Low Levels of Serum Zinc Associate with Malnutrition Risk Assessed by the Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis

Abstract

We have clarified that malnutrition risk evaluated by the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is prevalent in patients with cirrhosis. Mineral elements (zinc, iron, magnesium, copper, manganese, and calcium) are micronutrients essential for versatile physiological processes and cellular bioactivities. However, the association between these trace elements and integral nutritional status is unclear in decompensated cirrhotics. We collected blood samples from hospitalized patients with cirrhosis, and serum trace element concentrations were examined by inductively coupled plasma mass spectrometry. Association of trace element levels with high malnutrition risk was determined by multivariate logistic regression model. Sera from 141 patients with decompensated cirrhosis were analyzed for a total of six trace element concentrations. No significant differences were observed between high and low/moderate RFH-NPT malnutrition risk groups with the exception of zinc. The serum zinc concentrations were significantly decreased in patients at high malnutrition risk when compared to low/moderate subjects (57.9 vs 68.1 μg/dL, P = 0.006). In terms of receiver operating characteristics curve, zinc < 64 μg/dL represented best discriminative capability with an area of 0.635 (95% CI: 0.542, 0.728). Patients in the group with zinc < 64 μg/dL had elevated RFH-NPT and MELD score, higher proportion of Child-Pugh class C and ascites, higher CRP, lower albumin and sodium than in the group with zinc ≥ 64 μg/dL. Zinc < 64 μg/dL was an independent risk factor for high malnutrition risk. Low levels of serum zinc referring to less than 64 μg/dL were associated with poor integral nutritional status in cirrhosis.

Dietary Zinc Status in Offspring of Pregnant Rats Fed on a Zinc-Deficient Diet Is Associated with Serum Albumin, Ast, and Alt Levels

“…Reporting that albumin levels decrease in parallel with low zinc levels in various diseases, especially liver diseases [17][18][19] is in strong agreement with the low zinc and albumin levels we obtained in our study.…”

“…In this respect, a relationship between liver and zinc is inevitable. At the same time, the deficiency of zinc, which is a powerful antioxidant element, in the body may contribute to deterioration in liver functions and/or the progression of chronic liver diseases [16,17]. Yang et al [17] reported a significant decrease in serum albumin levels of the patient group whose zinc was found to be significantly lower than the controls in a study performed on patients with cirrhosis.…”

“…At the same time, the deficiency of zinc, which is a powerful antioxidant element, in the body may contribute to deterioration in liver functions and/or the progression of chronic liver diseases [16,17]. Yang et al [17] reported a significant decrease in serum albumin levels of the patient group whose zinc was found to be significantly lower than the controls in a study performed on patients with cirrhosis. Similarly, it has been reported that serum zinc and albumin levels are significantly lower in patients with infections caused by acute phase response activation [18].…”

Association between serum trace elements and sleep disturbance in patients with decompensated cirrhosis

“…The values referring to 60.35 μg/dL of serum Zn in poor sleepers indeed corresponded to marginal diagnostic criterion according to proposed guideline (i.e., 60–80 μg/dL) as well as our previously established cutoff (i.e., <64 μg/dL). 29 , 53 Therefore, a low Cu diet with monitored Zn replacement is presumed to restore CZr for patients with decompensated cirrhosis and sleep disturbance, given these populations may already have high/normal Cu levels. Moreover, elevated CZr has also been linked to increased hepatocellular carcinoma-related mortality.…”

“…Measurement of serum trace elements was in agreement with our previously applied methodology. 29 Taking into consideration the circadian variability of serum trace elements, we collected all samples at the early morning from fasting participants within 24 h upon hospitalization. In brief, collected peripheral blood samples in serum separating tubes were kept at room temperature for 30 min, and then set out for centrifugating and storing at −80°C in aliquots.…”