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Katayama K, Kawaguchi T, Shiraishi K, Ito T, Suzuki K, Koreeda C, Ohtake T, Iwasa M, Tokumoto Y, Endo R, Kawamura N, Shiraki M, Hanai T, Habu D, Tsuruta S, Sakai H, Miwa Y, Kawada N, Kato A, Takei Y, Mine T, Kohgo Y, Seki T, Sata M, Ito Y, Fukui K, Nishiguchi S, Moriwaki H, Suzuki K. The Prevalence and Implication of Zinc Deficiency in Patients With Chronic Liver Disease. J Clin Med Res 2018; 10:437-444. [PMID: 29581807 PMCID: PMC5862092 DOI: 10.14740/jocmr3374w] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/20/2018] [Indexed: 12/16/2022] Open
Abstract
Background Patients with liver cirrhosis often exhibit zinc deficiency. Although zinc is involved in many bioactivities, many aspects of clinical implications of zinc deficiency in liver cirrhosis remain unclear. We aimed to reveal the prevalence and implications of zinc deficiency in liver cirrhosis by assessing associations with parameters such as clinical symptoms and laboratory data. Methods In 235 cirrhosis patients enrolled at multiple medical institutions in 2009, we assessed how blood zinc levels were associated with their clinical symptoms, patients characteristics, and liver function test results. Results Blood zinc levels were most strongly correlated with blood albumin levels among the study parameters (r = 0.587, P < 0.0001). When blood albumin levels were ≤ 3.5 g/dL, blood zinc levels were < 70 μg/dL in 88% of patients. Additionally, significant correlations were observed with age (r = -0.253, P = 0.0014), aspartate aminotransferase levels (r = -0.254, P = 0.0020), total bilirubin levels (r = -0.222, P = 0.0053), prothrombin time (r = -0.255, P = 0.0029), branched-chain amino acid to tyrosine ratio (r = 0.357, P < 0.0001), Child-Pugh score (r = 0.469, P < 0.0001), ammonia levels (r = -0.246, P = 0.0028), and total cholesterol levels (r = 0.314, P < 0.0001). Blood zinc levels were significantly lower in patients with edema/ascites (P < 0.0001), those with hepatic encephalopathy (P = 0.0215), those receiving oral diuretics (P = 0.0045), and those receiving oral branched-chain amino acids (P < 0.0001) than in those without these conditions. Conclusions Zinc deficiency is prevalent in cirrhosis patients, whereas nitrogen metabolic disorders, particularly hypoalbuminemia, can be an indicator of zinc deficiency. Thus, cirrhosis patients exhibiting a nitrogen metabolic disorder should be examined for the presence of zinc deficiency.
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Affiliation(s)
- Kazuhiro Katayama
- Department of Hepato-Biliary and Pancreatic Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 541-8567, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-cho, Kurume 830-0011, Japan
| | - Koichi Shiraishi
- Department of Gastroenterology, Tokai University School of Medicine, 143 Kasuya, Isehara 259-1193, Japan
| | - Toshifumi Ito
- Department of Gastroenterology, JCHO Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan
| | - Kazutomo Suzuki
- Department of Gastroenterology, Shuuwa General Hospital, 1200 Taniharanitta, Kasugabe 344-0035, Japan
| | - Chizu Koreeda
- Liver Disease Center, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi 570-8507, Japan
| | - Takaaki Ohtake
- Department of Gastroenterology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara 329-2763, Japan
| | - Motoh Iwasa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Yoshio Tokumoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shizugawa, Toon 791-0295, Japan
| | - Ryujin Endo
- Division of Gastroenterology and Hepatology, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Naohiro Kawamura
- Third Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka 181-8611, Japan
| | - Makoto Shiraki
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Tatsunori Hanai
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Daiki Habu
- Department of Nutritional Medicine, Osaka City University Graduate School of Human Life Science, 1-5-7 Asahimachi, Abeno-ku, Osaka 545-8586, Japan
| | - Satoru Tsuruta
- Deparment of Gastroenterology and Hepatology, NHO Beppu Medical Center, 1473 Ooaza Utikamada, Beppu 874-0011, Japan
| | - Hironori Sakai
- Deparment of Gastroenterology and Hepatology, NHO Beppu Medical Center, 1473 Ooaza Utikamada, Beppu 874-0011, Japan
| | | | - Norifumi Kawada
- Department of Hepatology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka 545-8586, Japan
| | - Akinobu Kato
- Department of Internal Medicine, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka 020-0866, Japan
| | - Yoshiyuki Takei
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Tetsuya Mine
- Department of Gastroenterology, Tokai University School of Medicine, 143 Kasuya, Isehara 259-1193, Japan
| | - Yutaka Kohgo
- Department of Gastroenterology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara 329-2763, Japan.,Center of Preventive Medicine, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara 329-2763, Japan
| | - Toshihito Seki
- Liver Disease Center, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi 570-8507, Japan
| | - Michio Sata
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-cho, Kurume 830-0011, Japan
| | - Yuri Ito
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 541-8567, Japan
| | - Keisuke Fukui
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 541-8567, Japan
| | - Shuhei Nishiguchi
- Division of Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Hisataka Moriwaki
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Kazuyuki Suzuki
- Department of Nutritional Science, Morioka University, 808 Sunakomi, Takizawa 020-0694, Japan
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Abstract
Lactic acidosis is a clinical condition due to accumulation of H(+) ions from lactic acid, characterized by blood lactate levels >5 mM and arterial pH <7.25. In addition to supportive care, treatment usually consists of intravenous NaHCO(3), with a resultant mortality >60%. Dichloroacetate (DCA) is a compound that lowers blood lactate levels under various conditions in both man and laboratory animals. It acts to increase pyruvate oxidation by activation of pyruvate dehydrogenase. We evaluated the effects of DCA in the treatment of two different models of type B experimental lactic acidosis in diabetic dogs: hepatectomy-lactic acidosis and phenformin-lactic acidosis. The metabolic and systemic effects examined included arterial blood pH and levels of bicarbonate and lactate; the intracellular pH (pHi) in liver and skeletal muscle; cardiac index, arterial blood pressure and liver blood flow; liver lactate uptake and extrahepatic splanchnic (gut) lactate production; and mortality. Effects of DCA were compared with those of either NaCl or NaHCO(3). The infusion of DCA and NaHCO(3), delivered equal amounts of volume and sodium, although the quantity of NaHCO(3) infused (2.5 meq/kg per h) was insufficient to normalize arterial pH. In phenformin-lactic acidosis, DCA-treated animals had a mortality of 22%, vs. 89% in those treated with NaHCO(3). DCA therapy increased arterial pH and bicarbonate, liver pHi and cardiac index, with increased liver lactate uptake and a fall in blood lactate. With NaHCO(3) therapy, there were decrements of cardiac index and liver pHi, with an increase in venous pCO(2) and gut production of lactate. Dogs with hepatectomy-lactic acidosis were either treated or pretreated with DCA. Treatment with DCA resulted in stabilization of cardiac index, a fall in blood lactate, and 17% mortality. NaHCO(3) was associated with a continuous decline of cardiac index, rise in blood lactate, and 67% mortality. In dogs pretreated with NaCl, mortality was 33%, but all dogs pretreated with DCA survived. Dogs pretreated with DCA also had lower blood lactate and higher arterial pH and bicarbonate than did those pretreated with NaCl.Thus, in either of two models of type B experimental lactic acidosis, treatment with DCA improves cardiac index, arterial pH, bicarbonate and lactate, and liver pHi. The mortality in dogs with type B lactic acidosis was significantly less in DCA-treated animals than in those treated with other modalities.
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