The associations among dietary zinc intakes and biomarkers of zinc status are unknown in apparently healthy children at high risk for zinc deficiency.
Objective
To assess associations among zinc-related parameters in a sample of Guatemalan school-aged children.
Methods
We assessed total dietary intakes and biomarkers of zinc status before and after receiving 6 months of zinc supplementation or placebo in 691 Guatemalan schoolchildren aged 6 to 11 years. Most of the children also received zinc-fortified milk from a government program that started shortly after the trial began. We assessed associations between zinc intakes and serum zinc, alkaline phosphatase (ALP), and albumin.
Results
At baseline, the prevalence of serum zinc < 65 μg/dL and dietary zinc intake below Estimated Average Requirements (EAR) (< 4 and < 7 mg/day for children < 9 and ≥ 9 years, respectively) were 21.6% and 39.4%, respectively. Pearson correlations between serum zinc concentration and dietary zinc intake, serum ALP, and serum albumin were r = 0.07, 0.15, and 0.07, respectively. At the 6-month follow-up, low serum zinc and low total (diet plus fortified milk) zinc intakes were observed in 1.2% and 0.0% of children in the zinc-supplemented group and 4.0% and 34.1% in the placebo group, respectively. Pearson correlations between serum zinc concentration and total zinc intake, serum ALP, and serum albumin were 0.10, 0.06, and −0.11 in the zinc-supplemented group and −0.04, 0.05, and 0.01 in the placebo group, respectively.
Conclusions
Zinc intake was inconsistently associated with markers of serum zinc concentration. Zinc fortification or supplementation attenuated the associations.
LopezADMathersCDEzzatiMJamisonDTMurrayCJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet2006;367:1747–57.
2.
WuehlerSEPeersonJMBrownKH. Use of national food balance data to estimate the adequacy of zinc in national food supplies: methodology and regional estimates. Public Health Nutr2005;8:812–9.
3.
LoweNMFeketeKDecsiT. Methods of assessment of zinc status in humans: a systematic review. Am J Clin Nutr2009;89:2040S–51S.
4.
BoyettJDSullivanJF. Distribution of protein-bound zinc in normal and cirrhotic serum. Metabolism1970;19:148–57.
5.
BatesJMcClainCJ. The effect of severe zinc deficiency on serum levels of albumin, transferrin, and prealbumin in man. Am J Clin Nutr1981;34:1655–60.
6.
PrasadASRabbaniPAbbasiiABowersoxEFoxMR. Experimental zinc deficiency in humans. Ann Intern Med1978;89:483–90.
7.
JohnsonPEHuntCDMilneDBMullenLK. Homeostatic control of zinc metabolism in men: zinc excretion and balance in men fed diets low in zinc. Am J Clin Nutr1993;57:557–65.
8.
JacksonMJJonesDAEdwardsRHSwainbankIGColemanML. Zinc homeostasis in man: studies using a new stable isotope-dilution technique. Br J Nutr1984;51:199–208.
9.
TaylorCMBaconJRAggettPJBremnerI. Homeostatic regulation of zinc absorption and endogenous losses in zinc-deprived men. Am J Clin Nutr1991;53:755–63.
10.
KingJCShamesDMWoodhouseLR. Zinc homeostasis in humans. J Nutr2000;130:1360S–6S.
11.
JacksonMJJonesDAEdwardsRH. Tissue zinc levels as an index of body zinc status. Clin Physiol1982;2:333–43.
12.
DiGirolamoAMRamirez-ZeaMWangMFlores-AyalaRMartorellRNeufeldLMRamakrishnanUSellenDBlackMMSteinAD. Randomized trial of the effect of zinc supplementation on the mental health of school-age children in Guatemala. Am J Clin Nutr2010;92:1241–50.
13.
GibsonRS. Assessment of chromium, copper, and zinc status. In: GibsonRS, ed. Principle of nutritional assessment. 2nd ed.Oxford: Oxford University Press; 2005:711–33.
14.
INCAP. Table de Composicion de Alimentos de CentroAmerica. Instituto de Nutricion de Centro America Y Panama (INCAP), Organizacion PanAmericana de la Salud (OPS). Guatemala. 2nd ed; 2007.
15.
WillettWC. Food frequency questionnaire. 2nd ed.New York: Oxford University Press; 1998:74–91.
16.
BrownKHRiveraJABhuttaZGibsonRSKingJCLonnerdalBRuelMTSandtromBWasantwisutEHotzC. 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 Bull2004;25:S99–203.
17.
HotzCPeersonJMBrownKH. Suggested lower cutoffs of serum zinc concentrations for assessing zinc status: reanalysis of the second National Health and Nutrition Examination Survey data (1976–1980). Am J Clin Nutr2003;78:756–64.
18.
GibsonRSAbebeYStablerSAllenRHWestcottJEStoeckerBJKrebsNFHambidgeKM. Zinc, gravida, infection, and iron, but not vitamin B-12 or folate status, predict hemoglobin during pregnancy in Southern Ethiopia. J Nutr2008;138:581–6.
19.
CohenJ. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Laurence Earlbaum Associates; 1988.
20.
RuzMCodoceoJHurtadoSMunozLGrasN. Characterization of the regional distribution of selenium in Chile using selenium in hens' eggs as a monitor. J Trace Elem Med Biol1995;9:156–9.
21.
BrownKHLanataCFYuenMLPeersonJMButronBLonnerdalB. Potential magnitude of the misclassification of a population's trace element status due to infection: example from a survey of young Peruvian children. Am J Clin Nutr1993;58:549–54.
22.
FriisHNdhlovuPMduluzaTKaonderaKSandstromBMichaelsenKFVennervaldBJChristensenNO. The impact of zinc supplementation on growth and body composition: a randomized, controlled trial among rural Zimbabwean schoolchildren. Eur J Clin Nutr1997;51:38–45.
23.
DrokeEAKennedyTSHubbs-TaitL. Potential for misclassification of micronutrient status in children participating in a Head Start program. J Am Diet Assoc2006;106:376–82.
24.
WillettW. Correction for the effects of measurement error. In: WillettW, ed. Nutritional Epidemiology. New York: Oxford University Press; 1998:302–320.
25.
de BenoistBDarnton-HillIDavidssonLFontaineOHotzC. Conclusions of the joint WHO/UNICEF/IAEA/IZiNCG interagency meeting on zinc status indicators. Food Nutr Bull2007;28:S480–4.
26.
GibsonRSHessSYHotzCBrownKH. Indicators of zinc status at the population level: a review of the evidence. Br J Nutr2008;99Suppl 3:S14–23.
27.
CavanKRGibsonRSGraziosoCFIsalgueAMRuzMSolomonsNW. Growth and body composition of periurban Guatemalan children in relation to zinc status: a cross-sectional study. Am J Clin Nutr1993;57:334–43.
28.
MahmoodiMRKimiagarSM. Prevalence of zinc deficiency in junior high school students of Tehran City. Biol Trace Elem Res2001;81:93–103.
29.
AgteVVChiplonkarSATarwadiKV. Factors influencing zinc status of apparently healthy indians. J Am Coll Nutr2005;24:334–41.
30.
GibsonRS. Laboratory assessment. In: GibsonRS, ed. Principles of nutritional assessment. 2nd ed.New York, NY: Oxford University Press; 2005:373–397.
31.
WoodRJ. Assessment of marginal zinc status in humans. J Nutr2000;130:1350S–4S.
32.
HambidgeKMChavezMNBrownRMWalravensPA. Zinc nutritional status of young middle-income children and effects of consuming zinc-fortified breakfast cereals. Am J Clin Nutr1979;32:2532–9.
33.
UdomkesmaleeEDhanamittaSSirisinhaSCharoenkiatkulSTuntipopipatSBanjongORojroongwasinkulNKramerTRSmithJCJr. Effect of vitamin A and zinc supplementation on the nutriture of children in Northeast Thailand. Am J Clin Nutr1992;56:50–7.
34.
SchecterPJGirouxELSchliengerJLHoenigV, and SjoerdsmaA. Distribution of serum zinc between albumin and α-2 macroglobulin in patients with decompensated hepatic cirrhosis. European Journal of Clinical Investigation1976;6:147–50.
35.
WebberMKrishnanAThomasNGCheungBM. Association between serum alkaline phosphatase and C-reactive protein in the United States national health and nutrition examination survey 2005–2006. Clin Chem Lab Med2010;48:167–73.
36.
MazariegosMHambidgeKMKrebsNFWestcottJELeiSGrunwaldGKCamposRBarahonaBRaboyVSolomonsNW. Zinc absorption in Guatemalan schoolchildren fed normal or low-phytate maize. Am J Clin Nutr2006;83:59–64.
37.
FitzgeraldSLGibsonRSde SerranoQuan JPortocarreroLVasquezAde ZepedaELopez-PalaciosCYThompsonLUStephenAMSolomonsNW. Trace element intakes and dietary phytate/Zn and Ca x phytate/Zn millimolar ratios of periurban Guatemalan women during the third trimester of pregnancy. Am J Clin Nutr1993;57:195–201.
38.
PanteghiniMBaisR, and van SoilingWW. Enzymes. In: BurtisCA, ed. TIETZ textbook of clinical chemistry and molecular diagnostics. 4th ed.St. Louis, Missouri, US: Elsevier Saunders; 2006:607–12.
