Serum Zinc Level Classification System: Usefulness in Patients with Liver Cirrhosis

Abstract

Currently, the Japanese society of clinical nutrition (JSCN) defines serum zinc (Zn) level < 60 μg/dL as Zn deficiency and 60 μg/dL ≤ serum Zn level < 80 μg/dL as subclinical Zn deficiency, and 80 μg/dL ≤ serum Zn level < 130 μg/dL as normal Zn range. We aimed to elucidate the prognostic impact of this Zn classification system in patients with liver cirrhosis (LC) compared to the Child–Pugh classification and the albumin–bilirubin (ALBI) grading system (n = 441, median age = 66 years). The Akaike information criterion (AIC) with each evaluation method was tested in order to compare the overall survival (OS). The median serum Zn level was 65 μg/dL. There were 56 patients with normal Zn level, 227 with subclinical Zn deficiency and 158 with Zn deficiency. OS was well stratified among three groups of serum Zn level (p < 0.0001). The AIC value for survival by the Zn classification system was the lowest among three prognostic models (AIC: 518.99 in the Child–Pugh classification, 502.411 in ALBI grade and 482.762 in the Zn classification system). Multivariate analyses of factors associated with OS revealed that serum Zn classification by JSCN was an independent factor. In conclusion, the serum Zn classification proposed by JSCN appears to be helpful for estimating prognosis in LC patients.

Serum Zinc Level Grading System: A Useful Model for Composite Hepatic Events in Hepatitis C Virus-Associated Liver Cirrhosis

“…In our previous study, we reported that the serum Zn level grading system proposed by JSCN seems to be helpful for estimating OS in LC patients [31]. In the current results, the serum Zn level grading system proposed by JSCN had the lowest AIC value among the three prognostic models for the incidence of Com-HEs in all cases and in several subgroups.…”

“…As mentioned in the introduction section, JSCN defines Zn deficiency, subclinical Zn deficiency, and a normal Zn value based on the serum Zn level [31]. However, the predictability of the serum Zn level grading system in HCV-related LC patients on the incidence of Com-HEs has not been fully investigated, which motivated us to perform the current analysis.…”

“…A total of 275 subjects were thus analyzed in this analysis. The same baseline patient data as our previous reports [31] were used for analysis in cases where data was available.…”

“…Currently, the Japanese society of clinical nutrition (JSCN) defines serum Zn level <60 µg/dL as having Zn deficiency, 60 µg/dL ≤ serum Zn level < 80 µg/dL as having subclinical Zn deficiency, and 80 µg/dL ≤ serum Zn level < 130 µg/dL as having a normal Zn value. In our previous investigation, we reported that the serum Zn grading system proposed by JSCN can be more useful for predicting overall survival (OS) in patients with LC compared with the Child-Pugh classification system or ALBI grading system using the Akaike information criterion (AIC) [31]. However, the impact of this Zn level grading system in patients with HCV-related LC on the incidence of Com-HEs remains unclear.…”

Serum Zinc Level and non-Protein Respiratory Quotient in Patients with Chronic Liver Diseases

“…(Figure 2A) The median (IQR) serum Zn level in patients with npRQ < 0.85 (n = 242, 58 µg/dL (47, 66.25 µg/dL)) was significantly lower than that in patients with npRQ ≥ 0.85 (n = 344, 68 µg/dL (61, 75 µg/dL)) (p < 0.0001). ( Figure 2B) Currently, the Japanese society of clinical nutrition (JSCN) defines the followings: (A) serum Zn level <60 µg/dL corresponds to Zn deficiency; (B) 60 µg/dL ≤ serum Zn level < 80 µg/dL corresponds to subclinical Zn deficiency; and (C) 80 µg/dL ≤ serum Zn level < 130 µg/dL corresponds to normal Zn level [33]. The median npRQ levels in patients with Zn deficiency (n = 211), subclinical Zn deficiency (n = 305) and normal Zn range (n = 70) were: 0.82 (0.78, 0.86), 0.88 (0.84, 0.95) and 0.94 (0.8375, 1.01) (p < values: Zn deficiency versus subclinical Zn deficiency, p < 0.0001; subclinical Zn deficiency versus normal Zn level, p = 0.0038; Zn deficiency versus normal Zn level, p < 0.0001; overall p < 0.0001) ( Figure 2C).…”