Gau J, Ebersbacher C, Kao T. Serum Zinc Concentrations of Adults in an Outpatient Clinic and Risk Factors Associated With Zinc Deficiency. J Am Osteopath Assoc 2020;120(11):796–805. doi: https://doi.org/10.7556/jaoa.2020.138.
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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.
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.
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.
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.
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.
a Zinc deficiency was defined as serum zinc concentration less than 0.66 mcg/mL (normal range, 0.66 to 1.10).
b Data given as No. (%) unless otherwise noted.
c Significant weight loss was defined as weight loss >10% or >10 lb loss compared with 1 year prior.
d P values were estimated by Fisher exact test.
Abbreviation: SD, standard deviation.
a Zinc deficiency was defined as serum zinc concentration less than 0.66 (mcg/mL).
b n out of 41 patients in the zinc deficiency case group, unless otherwise stated.
c n out of 116 patients in the control group, unless otherwise stated.
d Statistical significance.
Abbreviations: Hb, hemoglobin; SD, standard deviation.
b Variables were dichotomized as 1=yes, 0=no (baseline) except age and body mass index. Hosmer and Lemeshow goodness-of-fit test: χ2=2.514, df=8, P=.961.
Abbreviations: CI, confidence interval; f, female; m, male; OR, odds ratio.
a Variables were dichotomized as 1=yes, 0=no except age and body mass index. R2 =0.228; adjusted R2=0.186.
Abbreviations: CI, confidence interval; F, female; Hb, hemoglobin; M, male.
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