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J Clin Med Res. 2018 May;10(5):437-444. doi: 10.14740/jocmr3374w. Epub 2018 Mar 16.

The Prevalence and Implication of Zinc Deficiency in Patients With Chronic Liver Disease.

Author information

1
Department of Hepato-Biliary and Pancreatic Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 541-8567, Japan.
2
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-cho, Kurume 830-0011, Japan.
3
Department of Gastroenterology, Tokai University School of Medicine, 143 Kasuya, Isehara 259-1193, Japan.
4
Department of Gastroenterology, JCHO Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan.
5
Department of Gastroenterology, Shuuwa General Hospital, 1200 Taniharanitta, Kasugabe 344-0035, Japan.
6
Liver Disease Center, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi 570-8507, Japan.
7
Department of Gastroenterology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara 329-2763, Japan.
8
Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan.
9
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shizugawa, Toon 791-0295, Japan.
10
Division of Gastroenterology and Hepatology, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan.
11
Third Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka 181-8611, Japan.
12
Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
13
Department of Nutritional Medicine, Osaka City University Graduate School of Human Life Science, 1-5-7 Asahimachi, Abeno-ku, Osaka 545-8586, Japan.
14
Deparment of Gastroenterology and Hepatology, NHO Beppu Medical Center, 1473 Ooaza Utikamada, Beppu 874-0011, Japan.
15
Miwa Clinic, 3-3 Nagarahigashi, Gifu 502-0082, Japan.
16
Department of Hepatology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka 545-8586, Japan.
17
Department of Internal Medicine, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka 020-0866, Japan.
18
Center of Preventive Medicine, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara 329-2763, Japan.
19
Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 541-8567, Japan.
20
Division of Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan.
21
Department of Nutritional Science, Morioka University, 808 Sunakomi, Takizawa 020-0694, Japan.

Abstract

Background:

Patients with liver cirrhosis often exhibit zinc deficiency. Although zinc is involved in many bioactivities, many aspects of clinical implications of zinc deficiency in liver cirrhosis remain unclear. We aimed to reveal the prevalence and implications of zinc deficiency in liver cirrhosis by assessing associations with parameters such as clinical symptoms and laboratory data.

Methods:

In 235 cirrhosis patients enrolled at multiple medical institutions in 2009, we assessed how blood zinc levels were associated with their clinical symptoms, patients characteristics, and liver function test results.

Results:

Blood zinc levels were most strongly correlated with blood albumin levels among the study parameters (r = 0.587, P < 0.0001). When blood albumin levels were ≤ 3.5 g/dL, blood zinc levels were < 70 μg/dL in 88% of patients. Additionally, significant correlations were observed with age (r = -0.253, P = 0.0014), aspartate aminotransferase levels (r = -0.254, P = 0.0020), total bilirubin levels (r = -0.222, P = 0.0053), prothrombin time (r = -0.255, P = 0.0029), branched-chain amino acid to tyrosine ratio (r = 0.357, P < 0.0001), Child-Pugh score (r = 0.469, P < 0.0001), ammonia levels (r = -0.246, P = 0.0028), and total cholesterol levels (r = 0.314, P < 0.0001). Blood zinc levels were significantly lower in patients with edema/ascites (P < 0.0001), those with hepatic encephalopathy (P = 0.0215), those receiving oral diuretics (P = 0.0045), and those receiving oral branched-chain amino acids (P < 0.0001) than in those without these conditions.

Conclusions:

Zinc deficiency is prevalent in cirrhosis patients, whereas nitrogen metabolic disorders, particularly hypoalbuminemia, can be an indicator of zinc deficiency. Thus, cirrhosis patients exhibiting a nitrogen metabolic disorder should be examined for the presence of zinc deficiency.

KEYWORDS:

Albumin; Ammonia; Branched-chain amino acid; Liver cirrhosis; Nitrogen metabolism

Conflict of interest statement

The authors declare that they have no conflict of interest.

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