Effects of dietary copper on human autonomic cardiovascular function

Increased oxidative stress and altered serum macro-minerals and trace elements levels are associated with coronary artery disease

BACKGROUND

This study was designed to evaluate the serum malondialdehyde (MDA), non-enzymatic antioxidants (vitamin A and C), macro-minerals (magnesium and calcium), and trace elements (zinc, copper, and iron) levels in patients with coronary artery disease (CAD) and to explore their role in disease progression.

METHODS

This prospective case-control study was comprised of 40 CAD patients and 40 healthy volunteers as cases and control subjects, respectively. The level of lipid peroxidation was assessed by measuring the serum MDA level using a UV spectrophotometer. The levels of vitamins A and C were determined by high-performance liquid chromatography (HPLC) and UV spectrophotometric method, respectively. Atomic absorption spectroscopy (AAS) was used to measure serum macro-minerals (Mg and Ca) and trace elements (Zn, Cu, and Fe) concentrations.

RESULTS

The mean age of CAD patients and control subjects was 53.90 ± 2.22 and 37.03 ± 1.50 years, respectively. This study revealed significantly higher concentrations of MDA (p < 0.01) and lower concentrations of vitamin A (p < 0.01), and vitamin C (p < 0.05) in the CAD patients than in control subjects. The mean values of Mg, Cu, Zn, Ca, and Fe were 11.67 ± 0.64, 1.17 ± 0.03, 0.43 ± 0.02, 107.38 ± 1.81, and 1.66 ± 0.04 μg/mL, respectively for the CAD patients and 19.38 ± 0.65, 1.07 ± 0.02, 0.87 ± 0.02, 94.29 ± 1.89, and 1.52 ± 0.05 μg/mL, respectively for the controls and the differences were significant (p < 0.05) between the patients and controls.

CONCLUSION

From these findings, we can suggest that there is a strong association of CAD with an elevated level of MDA, depleted levels of antioxidants, and altered macro-minerals and trace elements concentrations.

The comparison of zinc, copper and iron levels in serum, aorta and left internal mammarian artery tissues in coronary by-pass graft surgery patients

Trace elements are crucial for vital enzymatic reactions in all metabolic processes. Zinc (Zn) acts as a co-factor for many enzymes. Copper (Cu) and iron (Fe) have pro-atherogenic effects resulting in atherosclerosis. Aorta exposing high pulsatile pressure is sensitive for atherosclerosis because of its fast metabolism and poor nutrition by diffusion from vasa vasorum. We aimed to determine the relationship between serum Zn, Cu and Fe levels with aortic and left internal mammary artery (LIMA) tissues in 33 atherosclerotic individuals who inevitably underwent coronary artery by-pass graft (CBAG) surgery that is an end-point treatment for atherosclerosis. Trace elements in serum and tissues were measured using inductively coupled plasma-optical emission spectrophotometer. Pre-operative (Pre-op) serum Fe levels were statistically 46% higher than post-operative (Post-op) values (p = 0.009). Aortic Fe level was 49.8% higher than LIMA Fe (p = 0.0001). Our study points out the tendency of aortic tissue to atherosclerosis via pro- atherogenic effect of Fe. LIMA, being a potential graft for CBAG, is resistant to atherosclerosis with its intimal specialty of graft patency. In conclusion, serum Zn, Cu and Fe levels in atherosclerotic CBAG patients might be monitored to reveal minor alterations pre-operatively and post-operatively for ameliorating the treatment and life quality.

Endothelial dysfunction biomarker, endothelial cell-specific molecule-1, and pediatric metabolic syndrome

BACKGROUND

The aim of this study was to compare serum endothelial cell-specific molecule-1 (endocan) in pediatric patients with metabolic syndrome (MetS) and in healthy children, and to determine whether it can be used as an indicator of endothelium damage-induced complications in pediatric MetS patients.

METHODS

The study included 30 patients, aged 6-16 years, who were diagnosed with MetS. Another 30 children with no diseases were recruited as healthy controls. Endocan concentration was measured using enzyme-linked immunosorbent assay.

RESULTS

Endocan was increased almost threefold in the MetS group compared with the healthy group. Systolic arterial tension and diastolic arterial tension, serum triglyceride, total cholesterol, and low-density lipoprotein cholesterol were higher, and high-density lipoprotein cholesterol was lower, in the MetS children than in the healthy group. Fasting blood glucose (FBG), hemoglobin A1c (HBA1C), and homeostasis model assessment insulin resistance (HOMA-IR) were also significantly increased in the children with MetS compared with the healthy group.

CONCLUSIONS

Serum endocan level in pediatric MetS patients could be an important indicator of cardiovascular risk in adulthood.

IHD from copper deficiency: a unified theory

The theory, in brief outline here, implicating deficiency of Cu in the aetiology and pathophysiology of IHD explains more attributes of the disease than any other theory. This theory satisfies several of Hill's criteria of a half-century ago for deducing association between an environmental feature and presence of an illness. Most important is the temporal association between the rise of IHD and the decrease in dietary Cu since the 1930s along with a parallel increase in the supplementation of pregnant women with Fe, a Cu antagonist. There are more than eighty anatomical, chemical and physiological similarities between animals deficient in Cu and individuals with IHD. Few of these similarities have been produced by other dietary manipulations because feeding cholesterol induces Cu deficiency in animals. The most recent of these to be identified is decreased serum dehydroepiandrosterone. Some concomitant aspects of Cu metabolism and utilisation have been identified in other theories about heart disease: fetal programming, homocysteine, and Fe overload.

Zinc and copper levels are not correlated with angiographically-defined coronary artery disease in sudanese patients

We investigated zinc and copper levels in angiographically defined obstructive coronary artery disease (CAD) in patients undergoing elective coronary angiography in El-Shaab Hospital, Sudan. We performed a cross-sectional study. One hundred forty-two patients were enrolled. Sociodemographic and medical characteristics were collected using a questionnaire. Glucose, lipid, zinc, and copper levels were measured. Out of 142 patients, 102 (71.8%) had CAD and 40 (28.2%) had patent coronary arteries. There were no significant differences in median (interquartile range) zinc [118.5 (97.2-151.0) vs. 130.0 (106.0-174.0) μg/ml, P = 0.120] and copper [150.6 (125.0-183.0) vs. 158 (132.0-180.0) μg/mL, P = 0.478] levels between patients with CAD and those with patent coronary arteries. In linear regression analysis, there were no associations between CAD and zinc and copper levels. The current study failed to show any significant association between CAD and zinc and copper levels.

Association of serum concentrations of magnesium and some trace elements with cardiometabolic risk factors and liver enzymes in adolescents: the CASPIAN-III Study

This study aims to investigate the association of serum concentrations of magnesium (Mg), selenium (Se), chromium (Cr), and copper (Cu) with cardiometabolic risk factors and liver functions in Iranian children and adolescents. This case-control study was conducted under a national surveillance program. It comprised 320 students, aged 10-18 years, in two groups of equal number with or without metabolic syndrome (MetS). Serum concentrations of Mg and abovementioned trace elements were measured by atomic absorption spectrophotometry. Median regression analysis and different models of logistic regression were used to determine the associations of these elements with cardiometabolic risk factors. In the MetS group, the median of Mg, Se, Cr, and Cu was lower or equal to controls. Mg had significant inverse association with some MetS components; however, the corresponding figure was stronger for the simultaneous association of Mg, Se, Cr, and Cu with MetS components. The binary logistic regression revealed that Mg was a significant protective factor against MetS (P = 0.0001). Likewise, by considering the simultaneous association of Mg, Se, Cr, and Cu with MetS, Se was a significant protective factor against MetS. The corresponding figures were not significant for Cr and Cu. Se and Cu had significant inverse association with liver enzymes. The protective role of Mg and Se against MetS and liver enzymes, as well as the associations of these elements with some cardiometabolic risk factors and liver enzymes in the pediatric age group should be considered in future preventive and interventional studies.

Trace elements in the blood of institutionalized elderly in the Czech Republic

Whole blood selenium, copper, zinc and manganese concentrations of 197 institutionalized senior citizens (46 males, 151 females) aged 61-100 years (mean age 83.6 years) were determined using atomic absorption spectrometry and inductively coupled plasma mass spectrometry from two localities in the Czech Republic (Prague and Teplice) from 2009 through 2011. Geometric means (GM) of whole blood selenium (B-Se), copper (B-Cu), zinc (B-Zn) and manganese (B-Mn) levels were 74.0 μg/l, 941.0 μg/l, 5898.0 μg/l and 10.9 μg/l, respectively. Gender-related differences were found with significantly higher B-Cu levels in women and significantly higher B-Zn levels in men. The percentage of seniors with B-Se levels lower than 56 μg/l (which is equivalent to the critical value of 45 μg/l of Se in serum (S-Se)) was 8.6%. A negative correlation between age and B-Se levels was found. B-Zn positively correlated with serum albumin and prealbumin whereas a negative correlation between age and B-Zn was observed. Seniors with diabetes mellitus and atherosclerosis had higher B-Cu and B-Mn levels, respectively, than those without these diagnoses. The elderly from Prague had significantly higher B-Mn concentrations than those from Teplice. We found no evidence of serious essential elements deficiencies or excesses in the seniors who participated in this study.

Is the Western diet adequate in copper?

Copper has been known to be essential for health for more than three quarters of a century. Myriad experiments with animals reveal that the cardiovascular, musculoskeletal and nervous systems are most sensitive to deficiency. Copper in the Western diet has been decreasing at least since the 1930s; half of the adult population consumes less than the amount recommended in the European Communities and the United Kingdom. At least one fourth of adults consume less than the estimated average requirement published for the United States and Canada. Hundreds of people have been reported in journals about medicine and neurology rather than nutrition to have impaired copper nutriture based on the criteria of low copper concentrations and low activities of enzymes dependent on copper in various fluids and tissues. In contrast, only 46 people have participated in depletion/repletion experiments needed to define requirements. Almost 1000 people have benefited from supplements containing copper in controlled trials. People deficient in copper are being identified increasingly; it is unknown if unusually high requirements or unusually low diets are causal. Alzheimer's disease, ischemic heart disease and osteoporosis are the most likely human illnesses from low copper intakes.

Trace elements, heavy metals and vitamin levels in patients with coronary artery disease

AIM

In the present study, we aimed to assess serum concentrations of zinc (Zn), copper (Cu), iron (Fe), cadmium (Cd), lead (Pb), manganese (Mn), vitamins A (retinol), D (cholecalciferol) and E (α-tocopherol) in patients with coronary artery disease (CAD) and to compare with healthy controls.

METHODS

A total of 30 CAD patients and 20 healthy subjects were included in this study. Atomic absorption spectrophotometry (UNICAM-929) was used to measure heavy metal and trace element concentrations. Serum α-tocopherol, retinol and cholecalciferol were measured simultaneously by high performance liquid chromatography (HPLC).

RESULTS

Demographic and baseline clinical characteristics were not statistically different between the groups. Serum concentrations of retinol (0.3521 ± 0.1319 vs. 0.4313 ± 0.0465 mmol/I, p=0.013), tocopherol (3.8630 ± 1.3117 vs. 6.9124 ± 1.0577 mmol/I, p<0.001), cholecalciferol (0.0209 ± 0.0089 vs. 0.0304±0.0059 mmol/I, p<0.001) and Fe (0.5664 ± 0.2360 vs. 1.0689 ± 0,4452 µg/dI, p<0.001) were significantly lower in CAD patients. In addition, while not statistically significant serum Cu (1.0164 ± 0.2672 vs. 1.1934 ± 0.4164 µg/dI, p=0.073) concentrations were tended to be lower in patients with CAD, whereas serum lead (0.1449 ± 0.0886 vs. 0.1019 ± 0.0644 µg/dI, p=0.069) concentrations tended to be higher.

CONCLUSIONS

Serum level of trace elements and vitamins may be changed in patients with CAD. In this relatively small study we found that serum levels of retinol, tocopherol, cholecalciferol, iron and copper may be lower whereas serum lead concentrations may be increased in patients with CAD.

New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre?

Epidemiological studies have clearly shown that whole-grain cereals can protect against obesity, diabetes, CVD and cancers. The specific effects of food structure (increased satiety, reduced transit time and glycaemic response), fibre (improved faecal bulking and satiety, viscosity and SCFA production, and/or reduced glycaemic response) and Mg (better glycaemic homeostasis through increased insulin secretion), together with the antioxidant and anti-carcinogenic properties of numerous bioactive compounds, especially those in the bran and germ (minerals, trace elements, vitamins, carotenoids, polyphenols and alkylresorcinols), are today well-recognised mechanisms in this protection. Recent findings, the exhaustive listing of bioactive compounds found in whole-grain wheat, their content in whole-grain, bran and germ fractions and their estimated bioavailability, have led to new hypotheses. The involvement of polyphenols in cell signalling and gene regulation, and of sulfur compounds, lignin and phytic acid should be considered in antioxidant protection. Whole-grain wheat is also a rich source of methyl donors and lipotropes (methionine, betaine, choline, inositol and folates) that may be involved in cardiovascular and/or hepatic protection, lipid metabolism and DNA methylation. Potential protective effects of bound phenolic acids within the colon, of the B-complex vitamins on the nervous system and mental health, of oligosaccharides as prebiotics, of compounds associated with skeleton health, and of other compounds such as alpha-linolenic acid, policosanol, melatonin, phytosterols and para-aminobenzoic acid also deserve to be studied in more depth. Finally, benefits of nutrigenomics to study complex physiological effects of the 'whole-grain package', and the most promising ways for improving the nutritional quality of cereal products are discussed.

A deleterious interaction between copper deficiency and sugar ingestion may be the missing link in heart disease

Copper deficiency plays a vital role in atherogenesis. To the long list of risk factors for atherosclerotic cardiovascular disease should be added the deleterious interaction between copper deficiency and carbohydrate consumption. Here we critically evaluate the role of copper in the diet and its role as a possible etiological factor in the development of cardiovascular disease. A possible mechanism for the development of heart disease due to copper deficiency is proposed. There are many known risk factors for the development of heart disease, including hyperlipidemia and hypertension; however, little emphasis has been placed on the role of copper on heart disease. Over the last couple of decades, dietary copper deficiency has been shown to cause a variety of metabolic changes, including hypercholesterolemia, hypertriglyceridemia, hypertension, and glucose intolerance. Interestingly, these changes are common in the United States population and they are known risk factors for heart disease. Further research in this field is warranted considering the profound implications to people in the United States and around the world who consume processed foods marginally deficient in copper and replete with sugar. The only nutritional condition with signs and symptoms of atherosclerotic cardiovascular disease may be copper deficiency. Improving levels of copper in the diet, by appropriate food selection or by addition of a daily multi-vitamin, is recommended.

Pinto bean consumption changes SCFA profiles in fecal fermentations, bacterial populations of the lower bowel, and lipid profiles in blood of humans

Beans improve serum lipids and may reduce the risk of colon cancer by increasing colonic SCFA formation. We assessed whether pinto bean consumption affects in vitro fecal bacterial fermentation and production of SCFA, colonic bacterial populations, and serum lipids. Adults grouped as premetabolic syndrome (pre-MetSyn) (n = 40) or controls (n = 40) were randomly assigned to consume either a bean entrée [1/2 cup (130 g) of dried, cooked pinto beans] or an isocaloric chicken soup entrée daily for 12 wk. Measurements included in vitro fecal fermentation of various resistant starch substrates, fecal bacterial speciation, and blood lipids. When expressed as a difference between baseline and treatment, propionate production from fecal material fermented in vitro with bean flour was higher (P < 0.02) in volunteers consuming beans than in those consuming soup. During the treatment period alone, bean consumption did not affect propionic acid production with any substrate but lowered (P < 0.02) butyric acid production when cornstarch was the substrate. In all volunteers, bean consumption decreased fecal production of isovaleric (P < 0.05) and isobutyric (P < 0.002) acids from cornstarch by as much as 50%. Of the bacterial populations tested, only Eubacterium limosum was affected by bean consumption and was approximately 50% lower than in those consuming soup. Beans lowered serum total cholesterol (P < 0.014) by approximately 8% in the controls and 4% in the pre-MetSyn group. Bean consumption lowered serum HDL-cholesterol (P < 0.05) and LDL-cholesterol (P < 0.05) in both groups without affecting serum triglycerides, VLDL cholesterol, or glucose. This study provides evidence that bean consumption can improve lipid profiles associated with cardiovascular disease, but does not clearly confer health benefits related to colon cancer risk.

Calcium requirements: new estimations for men and women by cross-sectional statistical analyses of calcium balance data from metabolic studies

BACKGROUND

Low intakes of calcium are associated with an increased risk of both osteoporosis and cardiovascular disease.

OBJECTIVE

To provide new estimates of the average calcium requirement for men and women, we determined the dietary calcium intake required to maintain neutral calcium balance.

DESIGN

Calcium balance data [calcium intake -(fecal calcium + urinary calcium)] were collected from 155 subjects [women: n = 73; weight: 77.1 +/- 18.5 kg; age: 47.0 +/- 18.5 y (range: 20-75 y); men: n = 82; weight: 76.6 +/- 12.5 kg; age: 28.2 +/- 7.7 y (range: 19-64 y)] who participated in 19 feeding studies conducted in a metabolic unit. Balance data from the final 6-12 d of each dietary period (minimum length:18 d) of each study (1-9 observations per subject) were analyzed. Data were excluded if individual intakes of magnesium, copper, iron, phosphorus, or zinc fell below the estimated average requirements or exceeded the 99 th percentile of usual intakes from the 1994 Continuing Survey of Food Intakes by Individuals (for iron, above the upper limit). Daily intakes of calcium ranged between 415 and 1740 mg. The relation between intake and output was examined by fitting random coefficient models. Coefficients were included to test for sex and age differences.

RESULTS

The models predicted a neutral calcium balance [defined as calcium output (Y) equal to calcium intake (C)] at intakes of 741 mg/d [95% prediction interval (PI): 507, 1035; Y = 148.29 + 0.80C], 9.4 mg kg body wt(-1) d(-1) [95% PI: 6.4, 12.9; Y = 1.44 + 0.85C], or 0.28 mg kcal(-1) d(-1) [95% PI: 0.19, 0.38; Y = 0.051 + 0.816C]. Neither age nor sex affected the estimates when calcium intakes were expressed as mg/d or as mg kg body wt(-1) d(-1).

CONCLUSION

The findings suggest that the calcium requirement for men and women is lower than previously estimated.

Copper and human health: biochemistry, genetics, and strategies for modeling dose-response relationships

Copper (Cu) and its alloys are used extensively in domestic and industrial applications. Cu is also an essential element in mammalian nutrition. Since both copper deficiency and copper excess produce adverse health effects, the dose-response curve is U-shaped, although the precise form has not yet been well characterized. Many animal and human studies were conducted on copper to provide a rich database from which data suitable for modeling the dose-response relationship for copper may be extracted. Possible dose-response modeling strategies are considered in this review, including those based on the benchmark dose and categorical regression. The usefulness of biologically based dose-response modeling techniques in understanding copper toxicity was difficult to assess at this time since the mechanisms underlying copper-induced toxicity have yet to be fully elucidated. A dose-response modeling strategy for copper toxicity was proposed associated with both deficiency and excess. This modeling strategy was applied to multiple studies of copper-induced toxicity, standardized with respect to severity of adverse health outcomes and selected on the basis of criteria reflecting the quality and relevance of individual studies. The use of a comprehensive database on copper-induced toxicity is essential for dose-response modeling since there is insufficient information in any single study to adequately characterize copper dose-response relationships. The dose-response modeling strategy envisioned here is designed to determine whether the existing toxicity data for copper excess or deficiency may be effectively utilized in defining the limits of the homeostatic range in humans and other species. By considering alternative techniques for determining a point of departure and low-dose extrapolation (including categorical regression, the benchmark dose, and identification of observed no-effect levels) this strategy will identify which techniques are most suitable for this purpose. This analysis also serves to identify areas in which additional data are needed to better define the characteristics of dose-response relationships for copper-induced toxicity in relation to excess or deficiency.

Magnesium requirements: new estimations for men and women by cross-sectional statistical analyses of metabolic magnesium balance data

BACKGROUND

Current recommendations for magnesium requirements are based on sparse balance data.

OBJECTIVE

To provide new estimates of the average magnesium requirement for men and women, we pooled magnesium data from 27 different tightly controlled balance studies conducted at the US Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND.

DESIGN

Magnesium balance data (magnesium intake - [fecal magnesium + urinary magnesium]) (664 data points) were collected from 243 subjects (women: n = 150; weight: 71.6 +/- 16.5 kg; age: 51.3 +/- 17.4 y; men: n = 93, weight: 76.3 +/- 12.5 kg; age: 28.1 +/- 8.1 y). Data from the last 6-14 d of each dietary period (> or =28 d) of each study were analyzed and were excluded if individual intakes of calcium, copper, iron, phosphorus, or zinc fell below respective estimated average requirements (EARs) or exceeded 99th percentiles of usual intakes of those elements (iron: above the upper limit) from the 1994 Continuing Survey of Food Intakes by Individuals. Daily intakes of magnesium ranged between 84 and 598 mg. The relation between magnesium intake and magnesium output was investigated by fitting random coefficient models.

RESULTS

The models predicted neutral magnesium balance [defined as magnesium output (Y) equal to magnesium intake (M)] at magnesium intakes of 165 mg/d [95% prediction interval (PI): 113, 237 mg/d; Y = 19.8 + 0.880 M], 2.36 mg . kg(-1) . d(-1) (95% PI: 1.58, 3.38 mg . kg(-1) . d(-1); Y = 0.306 + 0.870 M), or 0.075 mg . kcal(-1) . d(-1) (95% PI: 0.05, 0.11 mg . kcal(-1) . d(-1); Y = 0.011 + 0.857 M). Neither age nor sex affected the relation between magnesium intake and output.

CONCLUSION

The findings suggest a lower magnesium requirement for healthy men and women than estimated previously.

Copper and zinc concentrations in serum of healthy Greek adults

Serum copper and zinc concentrations of 506 (414 males and 92 females) apparently healthy Greek blood donors aged 18-60 years old were determined by flame atomic absorption spectrometry. The mean copper and zinc concentrations were 115.46+/-23.56 microg/dl and 77.11+/-17.67 microg/dl, respectively. The mean value for copper and zinc in females was higher than in males, although the difference for zinc was smaller than the one observed for copper. When the subjects were divided into various age groups there appeared to be some increase in copper concentration as a function of age, whereas zinc concentration did not change. There were no significant variations in serum copper and zinc concentrations due to place of residence, occupation and socioeconomic status. This study is the first one evaluating the serum status of copper and zinc in healthy Greeks and it has shown that they are at the highest concentration range for copper and the lowest for zinc compared to literature data on copper and zinc levels for various countries.

Elastic fibres and vascular structure in hypertension

Blood vessels are dynamic structures composed of cells and extracellular matrix (ECM), which are in continuous cross-talk with each other. Thus, cellular changes in phenotype or in proliferation/death rate affect ECM synthesis. In turn, ECM elements not only provide the structural framework for vascular cells, but they also modulate cellular function through specific receptors. These ECM-cell interactions, together with neurotransmitters, hormones and the mechanical forces imposed by the heart, modulate the structural organization of the vascular wall. It is not surprising that pathological states related to alterations in the nervous, humoral or haemodynamic environment-such as hypertension-are associated with vascular wall remodeling, which, in the end, is deleterious for cardiovascular function. However, the question remains whether these structural alterations are simply a consequence of the disease or if there are early cellular or ECM alterations-determined either genetically or by environmental factors-that can predispose to vascular remodeling independent of hypertension. Elastic fibres might be key elements in the pathophysiology of hypertensive vascular remodeling. In addition to the well known effects of hypertension on elastic fibre fatigue and accelerated degradation, leading to loss of arterial wall resilience, recent investigations have highlighted new roles for individual components of elastic fibres and their degradation products. These elements can act as signal transducers and regulate cellular proliferation, migration, phenotype, and ECM degradation. In this paper, we review current knowledge regarding components of elastic fibres and discuss their possible pathomechanistic associations with vascular structural abnormalities and with hypertension development or progression.

Zinc requirements and the risks and benefits of zinc supplementation

The adult human contains 2-3g of zinc, about 0.1% of which are replenished daily. On this basis and based on estimates of bioavailability of zinc, dietary recommendations are made for apparently healthy individuals. Absent chemical, functional, and/or physical signs of zinc deficiency are assumed indicative of adequacy. More specific data are seldom available. Changing food preferences and availability, and new food preparation, preservation, and processing technologies may require re-evaluation of past data. Conservative estimates suggest that 25% of the world's population is at risk of zinc deficiency. Most of the affected are poor, and rarely consume foods rich in highly bioavailable zinc, while subsisting on foods that are rich in inhibitors of zinc absorption and/or contain relatively small amounts of bioavailable zinc. In contrast, among the relatively affluent, food choice is a major factor affecting risk of zinc deficiency. An additional problem, especially among the relatively affluent, is risk of chronic zinc toxicity caused by excessive consumption of zinc supplements. High intakes of zinc relative to copper can cause copper deficiency. A major challenge that has not been resolved for maximum health benefit is the proximity of the recommended dietary allowance (RDA) and the reference dose (RfD) for safe intake of zinc. Present recommendations do not consider the numerous dietary factors that influence the bioavailability of zinc and copper, and the likelihood of toxicity from zinc supplements. Thus the current assumed range between safe and unsafe intakes of zinc is relatively narrow. At present, assessment of zinc nutriture is complex, involving a number of chemical and functional measurements that have limitations in sensitivity and specificity. This approach needs to be enhanced so that zinc deficiency or excess can be detected early. An increasing number of associations between diseases and zinc status and apparently normal states of health, where additional zinc might be efficacious to prevent certain conditions, point at the pharmacology of zinc compounds as a promising area. For example, relationships between zinc and diabetes mellitus are an area where research might prove fruitful. In our opinion, a multidisciplinary approach will most likely result in success in this fertile area for translational research.

Low dietary magnesium increases supraventricular ectopy

BACKGROUND

Magnesium has been suggested to be beneficial in counteracting all phases of the processes that lead to ischemic heart disease, including terminal events such as arrhythmia and sudden death.

OBJECTIVE

We tested the hypothesis that an intake of magnesium considerably below the recommended dietary allowance can produce chemical and physiologic evidence of depletion.

DESIGN

Twenty-two postmenopausal women were maintained in a metabolic unit and ate a diet of conventional foods containing less than one-half of or more than the recommended dietary allowance for magnesium (320 mg/d). Dietary assignments were random and double blind in a crossover design. Magnesium concentrations were measured by spectroscopy and ion-specific electrolyte analysis, and Holter electrocardiograms lasting approximate 21 h were recorded.

RESULTS

Magnesium concentrations in erythrocytes, serum (total and ultrafilterable), and urine were significantly lower when dietary magnesium was lower. Holter monitors showed a significant increase in both supraventricular and supraventricular plus ventricular beats when the dietary magnesium concentration was low. Hypomagnesemia, hypocalcemia, and hypokalemia were not found.

CONCLUSIONS

The magnesium requirement was defined with the use of biochemical and electrophysiologic criteria. The recommended dietary allowance of 320 mg/d seems correct; 130 mg is too little. Persons who live in soft water areas, who use diuretics, or who are predisposed to magnesium loss or ectopic beats may require more dietary magnesium than would others.

Assessment of copper status in pregnancy by means of determining the specific oxidase activity of ceruloplasmin

BACKGROUND

Conditions not directly related to copper nutriture, such as pregnancy, infections and inflammation, which increase serum copper concentration even during copper deprivation, may be expected to conceal changes in copper status. It has been suggested that the specific enzymatic activity of ceruloplasmin (activity per unit mass of enzyme protein) may be a sensitive indicator of copper status and is not affected by factors such as hormones or sex. In this study, we investigated the behaviour of specific oxidase activity of ceruloplasmin and the copper/ceruloplasmin ratio in pregnant women.

METHODS

Copper, immunoreactive ceruloplasmin and its oxidase activity were determined in serum from 52 women in the last trimester of normal pregnancy, and in 50 control women of similar age living in the same area and who were not taking oral contraceptives. The results are expressed as mean+/-S.E.M.

RESULTS

In the group of pregnant women, significantly higher serum levels of copper, ceruloplasmin and its oxidase activity were found than in the control group (p < 0.001). In both groups, a high correlation was found between these biochemical variables (r > or =0.905, p < 0.001). However, in the group of pregnant women the specific oxidase activity for ceruloplasmin (364.4+/-3.3 vs. 407.5+/-3.8 U/g) and the copper/ceruloplasmin ratio (2.82+/-0.03 vs. 3.19+/-0.04 microg/mg) were significantly lower than in the control group (p < 0.001).

CONCLUSIONS

Although pregnancy accelerates the rate of ceruloplasmin protein synthesis and release with an increase of serum copper, the decrease in specific oxidase activity of circulating ceruloplasmin would be an indicator of the degree of depletion of the mother's copper deposits in order to deal with the foetus' needs.

Leucocyte copper, a marker of copper body status is low in coronary artery disease

To elucidate the relationship between leucocyte copper as a reliable, sensitive index of copper body status and extent of atherosclerosis in patients with Coronary Artery Disease (CAD) the present case-control study was carried out. 80 subjects were studied (23 females and 57 males), aged between 30-70, due to have a angiography. Individual angiograms were scored by combining the individual scores in all the major coronary arteries into one score of a scale 1.00 for patency to 0.00 for severe CAD. Serum and leucocyte copper and zinc were determined by GFAAS. No significant difference between patients with advanced CAD and relatively normal arteries were observed in the lipid profile and levels of plasma copper. Leucocyte copper had a significant link with the severity of atherosclerosis which was independent of sex. There was a linear relationship between the degree of decreasing leucocyte copper concentration and angiogram score. These findings give support to the hypothesis that marginal copper status, assessed by decreased leucocyte copper level, is associated with developing CAD.

Copper deficiency and cardiovascular disease: role of peroxidation, glycation, and nitration

Dietary copper deficiency causes a variety of cardiovascular deficits. Systemic effects include high blood pressure, enhancement of inflammation, anemia, reduced blood clotting, and possibly arteriosclerosis. Effects on specific organs or tissues include weakened structural integrity of the heart and blood vessels, impairment of energy use by the heart, reduced ability of the heart to contract, altered ability of blood vessels to control their diameter and grow, and altered structure and function of circulating blood cells. In some instances, the cause of a defect can be directly attributed to reduced activity of a specific copper-dependent enzyme. However, three nonspecific mechanisms of damage have been implicated in cardiovascular defects of copper deficiency. They are peroxidation, the interaction of oxygen-derived free radicals with lipids and proteins (possibly DNA); glycation, the nonenzymatic glycosylation of proteins; and nitration, the interaction of nitric oxide and its metabolites with peptides and proteins. Though independently these mechanisms present great potential for damage, the possibility that they may interact presents an added reason for concern. Furthermore, the fact that at least two of these mechanisms are associated with diabetes and aging suggests that copper deficiency may exacerbate deficits associated with these two conditions.Key words: copper, heart, circulation, peroxidation, glycation, nitric oxide.

Cardiovascular disease from copper deficiency--a history

Although the nutritional essentiality of copper was established in 1928, a preoccupation with hematology delayed the discovery of cardiovascular disease from copper deficiency for more than a decade. Anatomical studies of several species of deficient animals revealed, interalia, aortic fissures and rupture, arterial foam cells and smooth muscle migration, cardiac enlargement and rupture, coronary artery thrombosis and myocardial infarction. Abnormal biochemistry in deficiency probably contributes to these lesions, e.g., decreased activities of lysyl oxidase and superoxide dismutase which result in failure of collagen and elastin crosslinking and impaired defense against free radicals. Copper deficiency also decreases copper in hearts and other organs and cells and increases cholesterol in plasma. Abnormal physiology from deficiency includes abnormal electrocardiograms, glucose intolerance and hypertension. People with ischemic heart disease have decreased cardiac and leucocyte copper and decreased activities of some copper-dependent enzymes. Copper depletion experiments with men and women have revealed abnormalities of lipid metabolism, blood pressure control, and electrocardiograms plus impaired glucose tolerance. The Western diet often is as low in copper as that proved insufficient for these people. Knowledge of nutritional history can be useful in addressing contemporary nutritional problems.

Cardiovascular effects of dietary copper deficiency

Dietary copper deficiency may impair cardiovascular health by contributing to high blood pressure, enhancement of inflammation, anemia, reduced blood clotting and arteriosclerosis. The purpose of this review is to compile information on the numerous changes of the heart, blood and blood vessels that may contribute to these cardiovascular defects. These alterations include weakened structural integrity of the heart and blood vessels, impairment of the use of energy by the heart, reduced ability of the heart to contract, altered ability of blood vessels to control their diameter and to grow, and altered structure and function of circulating blood cells. The fundamental causes of these changes rest largely on reduced effectiveness of enzymes that depend on copper for their activity.

Lack of a recommended dietary allowance for copper may be hazardous to your health

The 10th edition of Recommended Dietary Allowances (RDA) did not include an RDA for copper; rather a safe and adequate daily intake was suggested. Criteria, history and uses of RDAs were summarized along with data on dietary intakes, balance and depletion experiments, low (fats and oils, skim milk and yogurt) and high (legumes, mushrooms, nuts and seeds) copper foods and hazards of zinc supplements. Bone disease and cardiovascular disease from diets-low in copper have been studied in animals for decades. Men and women fed diets close to 1 mg of copper per day, amounts quite frequent in the US, responded similarly to deficient animals with reversible, potentially harmful changes in blood pressure control, cholesterol and glucose metabolism, and electrocardiograms. Women supplemented with trace elements including copper experienced beneficial effects on bone density. These data exceed similar data on magnesium, selenium and zinc and are sufficient for establishing an RDA. Ischemic heart disease and osteoporosis are likely consequences of diets low in copper. Numerous anatomical, chemical and physiological similarities between animals deficient in copper and people with ischemic heart disease have been noticed. Association between osteoporosis and low copper status deserves further inquiry. Augmenting low copper diets with high copper foods may be beneficial. Committees that establish RDAs should return to the traditions of the first nine editions and make recommendations that promote health and nutritional welfare, meet functional needs, prevent disease and promote public welfare.

Serum copper in institutionalized elderly subjects: relations with dietary intake of energy, specific nutrients and haematological parameters

The concentrations of serum copper were determined as an indicator of corporal status of Cu and its relation to aging in 93 institutionalized elderly subjects (24 men and 69 women) in Granada (Spain). We found that aging does not affect serum Cu levels in the two age groups included in the study: Group I < 80 years and Group II > or = 80 years. Application of linear regression analysis to the serum Cu levels and the intake of energy, fibre, iron and magnesium showed a statistically significant negative correlation (P < 0.05) among them in all the subjects. However, no correlation was observed when the serum Cu levels were related to the intake of zinc or vitamin C. Therefore, at the daily intake levels of these two nutrients, they do not interfere in the absorption of copper and hence do not affect the corporal status of this element in the elderly. Blood erythrocyte and haemoglobin concentrations do not show any significant correlation with the serum Cu concentrations (P > 0.05).

Selenium status, plasma zinc, copper, and magnesium in vegetarians

Plasma zinc (Zn), copper (Cu), and magnesium (Mg) concentrations, copper/zinc ratio, and selenium (Se) status were studied in 44 vegetarians (22 males and 22 females) and their age- and sex-matched nonvegetarians in the Bratislava region (Slovakia). Vegetarians had statistically significant lower levels of plasma Zn and Cu than nonvegetarians, which may be the result of lower bioavailability of Zn and Cu from this type of diet. No differences in plasma Mg levels were found between vegetarians and nonvegetarians. Se status, as expressed by plasma and erythrocyte concentrations and plasma and erythrocyte glutathione peroxidase activities (GPx), was significantly lower in vegetarians when compared to nonvegetarians. In the series as a whole, there were significantly higher correlations between plasma and erythrocyte Se concentrations and between plasma and erythrocyte GPx activities. Significant positive correlations were also found between plasma Se concentrations and erythrocyte GPx activities, and between erythrocyte Se concentrations and erythrocyte GPx activities. A vegetarian diet does not provide a sufficient supply of essential antioxidant trace elements, like Zn, Cu, and especially Se. Se supplementation should be recommended to this risk group of the population.

Zinc, copper, and zinc- or copper-dependent enzymes in human hypertension

Imbalance of zinc and copper status has been hypothesized in human hypertension. A case-control study was carried out to elucidate the possible relationship between zinc and copper status and essential hypertension. Thirty-one subjects affected by mild stable hypertension, pharmacologically untreated, were investigated together with 31 normotensive controls individually matched for sex, age, and smoking habits. Zinc and copper in serum and urine wee measured, and serum activities of alkaline phosphatase (AP), lactic dehydrogenase (LDH), copper-zinc superoxide dismutase (Cu-Zn SOD), lysyl oxidase (LOX), and monoamine oxidase (MAO) were evaluated. No significant difference in serum and urine zinc and copper content as far as in serum activity of zinc (AP and LDH) or copper (Cu-Zn SOD, LOX, and MAO)-dependent enzymes was found between hypertensives and normotensives. Positive relationships were found in normotensives between serum and urine levels of zinc (r = 0.577; p = 0.001) and copper (r = 0.394; p = 0.028), and between serum copper and Cu-Zn SOD (r = 0.534; p = 0.002). In normotensives, diastolic blood pressure and serum zinc were positively related (r = 0.370; p = 0.041). In hypertensives, inverse correlations were observed between diastolic blood pressure and AP (r = -0.498; p = 0.004) and Cu-Zn SOD (r = 0.452; p = 0.011), and between systolic blood pressure and LOX (r = -0.385; p = 0.033). Diastolic blood pressure was related to LDH inversely in hypertensives (r = -0.357; p = 0.049) and positively in normotensives (r = 0.457; p = 0.010). In normotensives, diastolic blood pressure was inversely related with MAO (r = -0.360; p = 0.046). These findings support the hypothesis that an imbalance of zinc and copper status might be involved in human hypertension.

Relation of serum zinc and copper to lipids and lipoproteins: the Yi People Study

The relations of serum zinc (Zn) and copper (Cu) to serum total cholesterol (TC), low-density-lipoprotein and high-density-lipoprotein cholesterol (LDL-C and HDL-C) and triglycerides were investigated in a population-based sample of 399 men in Southern China. Serum Cu was inversely related to HDL-C (r = -0.21), while Zn/Cu ratio showed a positive association (r = 0.19). These relationships remained significant after adjusting for age, body mass index (kg/m2), physical activity, tobacco smoking and dietary cholesterol, fat, and fiber. While no significant association was observed between serum Cu and serum TC in univariate analysis, a significant negative association was observed in multivariate analysis, after adjustment for the above mentioned independent variables. No significant association between serum Cu and LDL-C was found. These observations, as well as those reported in other studies reviewed herein, suggest that Cu is implicated in the metabolism of HDL-C, although the mechanism involved is not fully understood. No significant associations were found between serum Zn and the lipid variables.

Altered metabolic response of iron-deficient women during graded, maximal exercise

Metabolic responses during a standardized, progressive, maximal work capacity test on a cycle ergometer were studied in 11 women, mean age 28 (SEM 2) years, at admission to the study, after their body iron stores were depleted by diet, phlebotomy and menstruation for about 80 days and after iron repletion by diet for about 100 days, including daily iron supplementation (0.9 mmol iron as ferrous sulfate) for the last 14 days of repletion. Iron depletion was characterized by a decline (P less than 0.05) in hemoglobin, ferritin and body iron balance. Iron repletion, including supplementation, increased (P less than 0.05) hemoglobin, ferritin and iron balance. No changes were observed in cardiovascular and ventilatory responses or peak oxygen uptake. Iron depletion was associated with a reduced (P less than 0.05) rate of oxygen utilization, total oxygen uptake and aerobic energy expenditure, and elevated (P less than 0.05) peak respiratory exchange ratio and post-exercise concentration of lactate. Reduction of body iron stores without overt anemia affects exercise metabolism by reducing total aerobic energy production and increasing glycolytic metabolism.

The effects of dietary copper deficiency and psychological stress on blood pressure in rats

In each of two experiments, adult, male Sprague-Dawley rats were deprived of copper and were subjected to the chronic stress of close confinement. A 2 X 2 factorial design was used because both copper deficiency and stress have been implicated in the regulation of blood pressure and are implicated in a major consequence of human hypertension--ischemic heart disease. Copper deficiency was verified by a decrease in copper in several organs. Both copper deficiency and stress increased blood pressure; results were independent. Sodium in heart was increased by deficiency in both experiments, but was increased in brain in only the second experiment. The combination of stress and deficiency produced an increase in mortality in one of two experiments. A decrease in cholesterol in plasma due to stress is consistent with earlier data from rats but is in contrast to data from humans. Both stress and copper deficiency produce potentially adverse changes in cardiovascular physiology and the chemistry of brain, heart and other organs. These results may be germane to humans because stress is frequent and some diets are low in copper.

Effects of exercise training on human copper and zinc nutriture

The findings of our three studies indicate no significant decreases in blood biochemical indices of copper and zinc nutritional status among female and male swimmers during physical training when dietary intakes of these trace elements are adequate (greater than or equal to 67% recommended safe and adequate intake). At these intakes, erythrocyte superoxide dismutase activity increased after physical training indicating a biochemical adaptation of human copper metabolism associated with exercise training. It is noteworthy that this increase in superoxide dismutase activity occurred without an apparent increase in daily copper intake. The calculated copper intakes were 1.3-1.4 and 1.6-1.9 mg/d in the female and male swimmers, respectively. These intakes are less than the suggested value of 2.0 mg/d (Committee on Dietary Allowances, 1980), but they are similar to the reported intakes of other groups in the United States (Klevay et al., 1979). In conclusion, these findings do not appear to support the belief that physical training per se produces adverse effects on copper and zinc nutriture.

Ischemic heart disease as copper deficiency

Atherosclerosis is a complex process beginning early in life and often leading to death from ischemic heart disease in middle age. Hundreds of factors are said to contribute to this risk. More than 50 similarities between animals deficient in copper and people with ischemic heart disease have been identified. Some of the more important characteristics of this illness have been produced in experiments in which men and women were fed diets low in copper. Diets with similarly low amounts of copper are readily available to the population at large. More aspects of the anatomy, biochemistry, chemistry, epidemiology, pathogenesis and pathophysiology of ischemic heart disease can be explained by considering this illness to be a problem of copper deficiency than by considering any of several other explanations that have been offered.