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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 21-24

A study of magnitude of zinc deficiency and effectiveness of zinc supplementation among elderly with zinc deficiency


1 Department of General Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
2 Department of Geriatrics, JSS Hospital, JSS AHER, Mysore, Karnataka, India
3 Department of Pharmacy Practice, JSS College of Pharmacy, Mysore, Karnataka, India

Date of Submission25-Sep-2019
Date of Decision01-Oct-2019
Date of Acceptance08-Oct-2019
Date of Web Publication13-Jan-2020

Correspondence Address:
Dr. Prathiba Pereira
Department of General Medicine, JSS Medical College and Hospital, Chairperson, Special Interest Group: Comprehensive Geriatrics Care, JSS Academy of Higher Education and Research, Mysore - 570 015, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_78_19

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  Abstract 


INTRODUCTION: Despite the significant role played by Zinc, the body stores of Zinc are very minimal and easily depleted. Zinc deficiency is known to be associated with various pathological conditions, including impaired immunity, delayed wound healing, retarded growth, neural development disorders and degenerative diseases. The loss experienced due to zinc deficiency sums to nearly 16 million global disability-adjusted life years (DALYs). This study focuses on the magnitude of Zinc deficiency and the effect of Zinc Supplementation among the hospitalized Elderly.
MATERIALS AND METHODS: A prospective interventional study has been carried out in Department of General Medicine, JSS medical college and hospital, Mysore, from November 2016 to August 2018. The serum zinc level was assessed by Zinc Colorimetric Method. Tools like Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA)-SF and The KATZ Index of Independence in Activities of Daily Living were used to collect relevant data from the participants.
RESULTS: A total of 100 elderly subjects were included in the final analysis. 38(38%) people had normal Zinc level. The mean serum Zinc levels pre and post interventions were reported to be 7.27 ± 1.33 gm/dl and 11.49 ± 1.83 gm/dl respectively. The difference in the pre and post intervention serum Zinc level was statistically significant (P value < 0.001). Among the people with Oral ulcers decreased taste before zinc supplementation only 6 (23.1%) participants had oral ulcers after supplementation. Decrease in vision before supplement 18 (78.3%) had improved after supplement. The difference between decreased vision before and after supplementation was statistically significant (P value-0.015).
CONCLUSION: The magnitude of zinc deficiency is noted in majority of the subjects. Supplementation in old age has a positive effect in Zinc levels. As ageing is a risk factor for Zinc deficiency, prophylactic doses of Zinc could be an option to prevent Zinc deficiency.

Keywords: Elderly, general medicine, geriatrics, zinc deficiency, zinc supplements


How to cite this article:
Kilaru S, Pereira P, Chandra B J, Hattur B, Chalasani SH. A study of magnitude of zinc deficiency and effectiveness of zinc supplementation among elderly with zinc deficiency. Int J Health Allied Sci 2020;9:21-4

How to cite this URL:
Kilaru S, Pereira P, Chandra B J, Hattur B, Chalasani SH. A study of magnitude of zinc deficiency and effectiveness of zinc supplementation among elderly with zinc deficiency. Int J Health Allied Sci [serial online] 2020 [cited 2020 Jan 18];9:21-4. Available from: http://www.ijhas.in/text.asp?2020/9/1/21/275658




  Introduction Top


Role of zinc (Zn) has its own importance in carrying out normal bodily functions and is also a part of many enzyme systems. Gene expression, cell division, immunity, and reproduction are the notable biological functions of zinc.[1] Zinc deficiency is known to be associated with various pathological conditions, including compromised immunity levels, delayed wound healing, retarded growth, neural development disorders, and degenerative diseases.[2],[3]

High risk of zinc deficiency is mainly seen among the developing countries, and 61% of the population is at an increased risk of low dietary zinc intake. India's agricultural soil is zinc deficient, and the average deficiency is projected to increase. In India, 26% of the population is at risk for zinc deficiency, with India's current population being 1.2 billion, which indicates that 312 million people in India are suffering from zinc deficiency.[1],[4] Briefel et al.[5] reported that only 44% of adults over 70 years had an adequate intake of Zn, and Prasad et al's[6] study reaffirms that Zinc deficiency in elderly is a “significant problem.” As age increases, dietary absorption of zinc reduces, especially among the old age, which makes them vulnerable to a higher risk for zinc deficiency. Age may be associated with altered metallothionein metabolism related to changes in zinc metabolism.[7]

Previous epidemiological studies recommend that people with low zinc blood levels are at greater risk of developing diseases or conditions related to the aging process, such as immune function impairment, cardiovascular disease,[8] or cancer. Risk group for zinc deficiency is dependent on the roles played by a combination of various factors such as zinc status, genetic makeup of the individual, and their daily dietary consumption. Among these factors, only dietary intake is modifiable, making zinc supplementation a prospective step for preventive interventions.

Aim and objectives

  1. To assess the magnitude of zinc deficiency among hospitalized elderly patients
  2. To assess the relationship between zinc status and inflammatory marker among hospitalized elderly
  3. To find out the effectiveness of oral zinc supplementation on the clinical manifestations of zinc deficiency.



  Materials and Methods Top


The current study is a prospective interventional study and was carried out in the Department of General Medicine, JSS Medical College and Hospital, Mysore, from November 2016 to August 2018. The study population included 100 elderly people above 65 years of age who were presenting to the Department of General Medicine.

Inclusion criteria

  1. People aged above 65 years
  2. Both genders.


Exclusion criteria

  1. Elderly not able to comprehend
  2. Elderly who are terminally ill
  3. Elderly who are already on zinc supplementation
  4. Those who were not consenting for the investigations.


A preintervention assessment was carried out among the participants who have satisfied the inclusion and exclusion criteria. The serum zinc level was assessed by zinc colorimetric method, using 5-Br-PAPS as the reagent. Along with the pro forma, structured and validated assessment tools were used for collecting relevant clinical and demographic information. Tools such as Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA)-SF, and the KATZ Index of Independence in Activities of Daily Living were used to collect relevant data from the participants. All the study participants who were found to have deficiency in zinc were supplemented with zinc, and a postintervention follow-up was also carried out for assessing any clinical improvement.

Statistical analysis

The data were analyzed using IBM SPSS statistical software version 20 (IBM Corp., Armonk, NY). The association between explanatory variables (zinc category) and categorical outcomes (GDS, MNA, total cholesterol, triglycerides, high-density lipoprotein [HDL], low-density lipoprotein [LDL], very LDL [VLDL] categories, and clinical complications) was assessed for testing the statistical significance.


  Results Top


A total of 100 elderly were included in the final analysis.

A total of 38 (38%) study participants had normal zinc level, and the remaining 62 (62%) people were reported to have decreasing levels of zinc [Table 1].
Table 1: Descriptive analysis of zinc levels in the study population (n=100)

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Majority of the study participants (34 [54.83%]) with decreased zinc levels have reported to be suffering with mild depression followed by 27 (43.54%) participants with severe depression. Similarly, mild and severe depression among the participants with normal zinc levels were found to be 31 (81.5%) and 1 (2.6%) participants, respectively. The difference between GDS category and zinc category was statistically significant (Chi-square: 23.443, P = 0.001) [Table 2] and [Figure 1].
Table 2: Association of zinc levels with Geriatric Depression Scale category in the study population

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Figure 1: Bar graph for the presence of symptoms distribution in the study population (n = 100)

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Malnourishment was seen among 43 (69.35%) participants with decreased zinc levels, and risk of malnourishment was reported in 18 (56.25%) participants. Similarly, malnourishment and risk of malnutrition among the participants with normal zinc levels were found to be 12 (31.57%) and 18 (47.36%), respectively. The difference between MNA category and zinc category was statistically significant (Chi-square: 18.206; P = 0.001) [Table 3].
Table 3: Association of zinc levels with Mini Nutritional Assessment category in the study population (n=100)

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The mean serum zinc level before the intervention was found to be 7.27 ± 1.33 g/dl and post intervention, the mean serum zinc level was raised to 11.49 ± 1.83 g/dl. The difference in the pre- and postintervention serum zinc level was statistically significant (P< 0.001). There was a moderate positive correlation between zinc level before supplementation and zinc level after supplementation (R = 0.646, P = 0.0001) [Table 4] and [Figure 2].
Table 4: Correlation between zinc levels before supplementation and zinc level after supplementation (n=30)

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Figure 2: Scatter plot for correlation between zinc level before supplementation and zinc level after supplementation (n = 30)

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  Discussion Top


The main etiological factor for the development of zinc deficiency is the variation in the bioavailability of dietary zinc. Zinc deficiency and susceptibility to infections due to cell-mediated immune dysfunction have been reported to occur in the elderly. Increased incidence of age-related pathologies has been documented in nutritional-deficient states.[9] Zinc plays a major role in oxidative stress, immunity, and cognitive function;[10] hence, it is imperative to maintain zinc status by preventing its deficiency or restoring zinc deficiency to normal state by supplementation among the elderly. The elderly population was selected, and mean age of the group was 73.38 ± 6.78 years (range: 63–91 years). An equal proportion of males and females was present in the study group (50:50). Among the study population, 38 (38%) participants had normal zinc level and the remaining 62 (62%) of them had decreased zinc levels. In our study, there was a statistically significant difference in the zinc deficiency status among men and women; 74% of male participants had decreased level of zinc in the study. Similarly, a higher mean serum level of zinc concentration in females has been reported in other studies.[11] Markovits et al.[12] in their study reported a decreased taste acuity among zinc-deficient individuals, which is comparable to the present study that had 74% of participants with decreased taste sensation.

In the present study, 73% of the participants had reported a defective vision. However, this cannot be attributable only to zinc deficiency, but to aging as a factor. Nearly 78% of the participants had a symptom of delayed wound healing, which was in line with the study by Evans.[13] Little et al.[14] have documented in their study that zinc-deficient individuals had loss of appetite; similar findings were observed in the present study, with 83% of the participants having loss of appetite. In the present study, there was a statistically significant difference between zinc and other parameters such as age, body mass index, GDS scoring, MNA score, albumin, erythrocyte sedimentation rate, total cholesterol, LDL, VLDL, triglycerides, and HDL. All these indicate that zinc plays a major role in various systems in the body.

In this study, 83% of the participants were dependent based on KATZ score and only 17% were independent in performing daily activities. Based on the Geriatric Depression Scale, 65% of the participants had mild depression, which can be correlated with the psychological effects of zinc deficiency. There was a moderate positive correlation between zinc level before supplementation and zinc level after supplementation, indicating that supplementation in old age has a positive effect in zinc levels.

As aging is a risk factor for zinc deficiency, prophylactic doses of zinc can be given to prevent zinc deficiency. Prophylactically, zinc and the development of zinc deficiency in the elderly can be the future study option to identify the dosage and regimen of prophylactic zinc. Almost all the symptoms of zinc deficiency reported by the study participants were reduced after the supplementation by zinc. This indicates that zinc deficiency was corrected by supplementation.


  Conclusion Top


The aging process indirectly causes reduction in the uptake of zinc, thereby leading to dietary deficiency. The study compared the symptoms of zinc deficiency before and after supplementation, thereby proving that zinc supplementation in old age reduces the signs and symptoms of deficiency, which indirectly indicates the correction of deficiency. Results from this study have showed that supplementation in old age has a positive effect in zinc levels. As aging is a risk factor for zinc deficiency, prophylactic doses of zinc could be an option to prevent zinc deficiency. Prophylactically, zinc and the development of zinc deficiency in the elderly can be the future study option to identify the dosage and regimen of prophylactic zinc.

Limitations

  1. The study findings must be generalized with caution, as the study was conducted in a single center catering to a limited population
  2. Possibility of potential confounding by various sociodemographic variables and clinical variables on the final zinc level and clinical features are the main limitations of the study.


Recommendations

  1. Considering the high prevalence of zinc deficiency, screening for zinc deficiency may be routinely done among elderly people and appropriate supplementation can be provided to zinc-deficient population
  2. There is a strong need for prospective randomized controlled trials assessing the efficacy of different doses and periods of zinc supplementation to identify the most appropriate dosage schedule.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
International Zinc Nutrition Consultative Group (IZiNCG), Brown KH, Rivera JA, Bhutta Z, Gibson RS, King JC, et al. International zinc nutrition consultative group (IZiNCG) technical document #1. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull 2004;25:S99-203.  Back to cited text no. 1
    
2.
Fukada T, Yamasaki S, Nishida K, Murakami M, Hirano T. Zinc homeostasis and signaling in health and diseases: Zinc signaling. J Biol Inorg Chem 2011;16:1123-34.  Back to cited text no. 2
    
3.
Prasad AS. Zinc is an antioxidant and anti-inflammatory agent: Its role in human health. Front Nutr 2014;1:14.  Back to cited text no. 3
    
4.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: Global and regional exposures and health consequences. Lancet 2008;371:243-60.  Back to cited text no. 4
    
5.
Briefel RR, Bialostosky K, Kennedy-Stephenson J, McDowell MA, Ervin RB, Wright JD. Zinc intake of the U.S. Population: Findings from the third national health and nutrition examination survey, 1988-1994. J Nutr 2000;130:1367S-73.  Back to cited text no. 5
    
6.
Prasad AS, Fitzgerald JT, Hess JW, Kaplan J, Pelen F, Dardenne M. Zinc deficiency in elderly patients. Nutrition 1993;9:218-24.  Back to cited text no. 6
    
7.
Wastney ME, Ahmed S, Henkin RI. Changes in regulation of human zinc metabolism with age. Am J Physiol 1992;263:R1162-8.  Back to cited text no. 7
    
8.
Salonen JT, Alfthan G, Huttunen JK, Pikkarainen J, Puska P. Association between cardiovascular death and myocardial infarction and serum selenium in a matched-pair longitudinal study. Lancet 1982;2:175-9.  Back to cited text no. 8
    
9.
Meydani M. Nutrition interventions in aging and age-associated disease. Ann N Y Acad Sci 2001;928:226-35.  Back to cited text no. 9
    
10.
Prasad AS, Bao B, Beck FW, Kucuk O, Sarkar FH. Antioxidant effect of zinc in humans. Free Radic Biol Med 2004;37:1182-90.  Back to cited text no. 10
    
11.
Schuhmacher M, Domingo JL, Corbella J. Zinc and copper levels in serum and urine: Relationship to biological, habitual and environmental factors. Sci Total Environ 1994;148:67-72.  Back to cited text no. 11
    
12.
Markovits PM, Sankey AW, James DK, McCabe R, Mahomed K, Golding J. Zinc taste test and postnatal depression. Br J Psychiatry 1990;156:451-2.  Back to cited text no. 12
    
13.
Evans GW. Zinc and its deficiency diseases. Clin Physiol Biochem 1986;4:94-8.  Back to cited text no. 13
    
14.
Little KY, Castellanos X, Humphries LL, Austin J. Altered zinc metabolism in mood disorder patients. Biol Psychiatry 1989;26:646-8.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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