Public Health and Primary Care  |   November 2020
Serum Zinc Concentrations of Adults in an Outpatient Clinic and Risk Factors Associated With Zinc Deficiency
Author Notes
  • From the Department of Primary Care at Heritage College of Osteopathic Medicine at Ohio University in Athens (Drs Gau and Ebersbacher), and the Department of Preventive Medicine and Biometrics at the Uniformed Services University of the Health Sciences in Bethesda, Maryland (Dr Kao). 
  • Preliminary results from this study were orally presented at the 12th International Academy on Nutrition and Aging Annual Meeting at Moscone Center West, San Francisco, California, on July 23, 2017. 
  • Disclaimer: The views expressed in this paper are those of the authors and do not necessarily reflect the official views of the institutions or the United States Department of Defense. 
  • Financial Disclosures: None reported. 
  • Support: This research project was partially funded by NIH grant 5R21DK096201-02 (Gau) and the Research and Scholarly Activity Committee (Ohio University Heritage College of Osteopathic Medicine). 
  •  *Address correspondence to Jen-Tzer Gau, MD, PhD, Ohio University, 355 Grosvenor Hall, 16 W Green Dr, Athens, OH 45701-2974. Email: gau@ohio.edu
     
Article Information
Public Health and Primary Care   |   November 2020
Serum Zinc Concentrations of Adults in an Outpatient Clinic and Risk Factors Associated With Zinc Deficiency
The Journal of the American Osteopathic Association, November 2020, Vol. 120, 796-805. doi:https://doi.org/10.7556/jaoa.2020.138
The Journal of the American Osteopathic Association, November 2020, Vol. 120, 796-805. doi:https://doi.org/10.7556/jaoa.2020.138
Abstract

Context: Subclinical features of zinc deficiency can be challenging to recognize. The prevalence of zinc deficiency based on blood zinc concentration in an adult outpatient clinic setting has not been well-studied.

Objective: To estimate the prevalence of low serum zinc concentrations among community-dwelling adults, and to characterize clinical features and risk factors associated with zinc deficiency.

Methods: This retrospective pilot prevalence study took place from 2014 to 2017 at an outpatient clinic in southeast Ohio. Patients aged 50 years or older with a stable health status were categorized into a case group with zinc deficiency (serum zinc concentration, <0.66 µg/mL) and a control group (serum zinc concentration, ≥0.66 µg/mL). Measurements included serum zinc concentration, nutritional biomarkers (ie, magnesium, calcium, albumin, and total 25-hydroxy vitamin D levels), patient history of fractures and events such as hospitalization, antibiotic use, and self-reported falls that occurred within 1 year prior to the date serum zinc concentration was measured (index date). Patients were excluded if they had a serum zinc measurement within 2 months after a hospitalization, severe renal insufficiency (3 patients with serum creatinine concentration above 2.5 mg/dL), or serum zinc concentration above 1.20 µg/mL.

Results: This study included 157 patients, consisting of a case group of 41 (26%) patients with zinc deficiency and a control group of 116 (74%) without zinc deficiency. Mean (SD) zinc concentrations of the case and control groups were 0.58 (0.05) µg/mL and 0.803 (0.13) µg/mL, respectively (P<.01). Patients in the case group were more likely to have had a history of hospitalization, antibiotic use, a fall within 1 year before the index date, and a history of fractures and hip fracture (P<.01 in each case). Patients taking gastric acid suppressants had increased odds of lower zinc concentrations (odds ratio, 2.24; 95% CI, 1.08-4.63). Both logistic and multivariate linear regression models revealed that past fractures, hip fractures, and hypoalbuminemia (albumin <3.5 g/dL) were associated with zinc deficiency or lower zinc concentrations.

Conclusion: This study revealed that 26% of patients in an outpatient adult clinic had zinc deficiency based on serum concentrations. Patients with fracture history and low serum albumin were at higher risk for zinc deficiency.

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