Zinc status in infants and children with cholestatic liver diseases and its effect on growth

Abstract

Objectives and study: Zinc deficiency in children with cholestatic liver diseases could affect growth and immunity. Zinc supplementation is one of the strategies to prevent the consequences of zinc deficiency in children. We aimed to study the effect of zinc supplementation on the growth of these children. Methods: Fifty-five infants and children (0.5-10 years) with cholestatic liver diseases enrolled from pediatrics hepatology clinic, Cairo University Hospital: 27 post-Kasai, 7 with Alagille syndrome, and 21 with progressive familial intrahepatic cholestasis. Serum zinc, insulin-like growth factor 1 (IGF-1), and anthropometric measurements are measured at enrollment and 4 months after zinc supplementation and in 30 healthy children with matched age and sex. Serum zinc was measured by atomic absorption spectrometry. Results: The mean initial serum zinc (± SD) in cholestatic and healthy control group was 1251 ± 558 and 1461 ± 506 ug/l, respectively (P > 0.05). Meanwhile, serum IGF1 median (IQR; range) in patients and control was 54 (118;10: 780) ng/ml and 250 (387;55:635) ng/ml, respectively (p < 0.001). No statistically significant difference was found between post-Kasai patients and other cholestatic diseases. Children supplemented with zinc had their serum zinc 2223 ± 1042 ug/l (P < 0.001) and IGF1 median (IQR; range) 346 (370;50:825) ng/ml (P < 0.001). In addition, among anthropometric variables, height (length) Z-score and percentile were significantly improved (P < 0.01). Conclusion: As compared with the baseline, zinc supplementation had significantly elevated serum zinc levels and IGF1 and improved growth in children with cholestatic liver diseases. Thus, zinc supplementation is beneficial for growth in children with cholestatic liver diseases.

Acquired Zinc Deficiency in Preterm Infant Post-Surgery for Necrotizing Enterocolitis (NEC) on Prolonged Total Parenteral Nutrition (TPN)

“…The diagnostic decision of an acquired zinc deficiency was made based on the low serum levels of zinc and clinical improvement following zinc supplementation. Similar cases have been reported previously, linking IFALD with the deficiency of dietary zinc, especially for infants born prematurely [ 3 , 7 , 16 , 29 ].…”

“…Zinc is one of the trace elements which cannot be stored in the human body, and hence a constant supply is to be sustained via diet to maintain its serum level around 700–1200 μg/L for viable functioning [ 29 , 30 , 31 ]. Poor nutrition, malabsorption, and loss of appetite has been linked to zinc deficiency in both adults and children [ 5 , 12 , 15 ].…”

“…Poor nutrition, malabsorption, and loss of appetite has been linked to zinc deficiency in both adults and children [ 5 , 12 , 15 ]. Administration of zinc at doses of 5–10 mg/day is recommended to reduce the risk of zinc deficiency in children with a high demand for nutrients [ 12 , 29 , 32 ]. Zinc deficiency is more severe in premature infants for several reasons: firstly, zinc is accumulated efficiently only during the late gestation period; secondly, the fetus receives zinc from the mother only during the last ten weeks of gestation; and thirdly, preterm newborns have a high requirement for all trace elements, including zinc, to support rapid growth and development [ 3 , 12 , 16 , 33 , 34 ].…”

Summary and Considerations in the Nursing Care of Patients with Progressive Familial Intrahepatic Cholestasis

“…Nurses should inform PFIC patients to insist on taking drugs Acid is important in relieving the deterioration of liver function in patients. Additionally, patients with PFIC often suffer from fat-soluble vitamins A, D, E, and K deficiency; therefore, it is necessary to inform patients and their families about the importance of supplementing fat-soluble vitamins, medium-chain fatty acids, and trace elements according to individual needs [11].…”

Zinc level in children with short stature

“…The key role of the microelements in the function-ing of all human organs and systems is pointed out in scientific studies [1][2][3][4]. A special emphasis is paid to the study of essential micronutrients (EM) impacton human health, and children with growth retardation in particular [5][6][7]. Zinc is one of these EM [8], being a part of more than 300 metal enzymes, it is involved in cellular metabolism, immune system functioning [9], Ref: Ro J Pediatr.…”