Analyzed dietary intakes, plasma concentrations of zinc, copper, and selenium, and related antioxidant enzyme activities in hospitalized elderly women

Comparison of Serum Iron, Zinc, and Selenium Levels in Premenopausal and Postmenopausal Women in Ekpoma, Nigeria: A Descriptive Study

Background: Estrogen deficiency following menopause creates an imbalance in plasma micronutrient resulting in several degenerative pathological conditions, including hypertension, cardiovascular disease, osteoporosis, etc. Objectives: The present study was designed to compare zinc (Zn), iron (Fe), and selenium (Se) concentrations between premenopausal and postmenopausal women. Methods: In this descriptive study a total of 200 participants were classified into two groups of postmenopausal (age range: 46-75 years, served as experimental) and premenopausal (age range: 30-45 years, served as control). Each group consisted of 100 subjects. After obtaining informed consent from all participants, blood samples were collected from the antecubital fossa vein of each participant by venipuncture. The concentrations of Fe, Zn, and Se in each blood sample were determined using Atomic Absorption Spectrophotometer. Results: No significant difference (P>0.05) was observed in serum Fe (114.24 ± 26.79 µg/dL), Zn (83.11 ± 20.45 µg/dL), and Se (41.99 ± 9.78 µg/dL) levels between the control and experimental groups. However, serum Fe and Zn showed progressive significant (P=0.04, 0.03, respectively) increase with increasing postmenopausal age. Conversely, serum Se concentration decreased significantly (P=0.03) with increasing menopausal age. Conclusion: Although no significant difference was observed in serum levels of Fe, Zn, and Se between pre- and post-menopausal women, the progressive significant increase in the serum Fe and Zn levels as well as significant decrease in serum Se level with advancing post-menopausal age portend a great risk.

Serum Zinc Concentrations of Adults in an Outpatient Clinic and Risk Factors Associated With Zinc Deficiency

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.

Zinc deficiency primes the lung for ventilator-induced injury

Mechanical ventilation is necessary to support patients with acute lung injury, but also exacerbates injury through mechanical stress-activated signaling pathways. We show that stretch applied to cultured human cells, and to mouse lungs in vivo, induces robust expression of metallothionein, a potent antioxidant and cytoprotective molecule critical for cellular zinc homeostasis. Furthermore, genetic deficiency of murine metallothionein genes exacerbated lung injury caused by high tidal volume mechanical ventilation, identifying an adaptive role for these genes in limiting lung injury. Stretch induction of metallothionein required zinc and the zinc-binding transcription factor MTF1. We further show that mouse dietary zinc deficiency potentiates ventilator-induced lung injury, and that plasma zinc levels are significantly reduced in human patients who go on to develop acute respiratory distress syndrome (ARDS) compared with healthy and non-ARDS intensive care unit (ICU) controls, as well as with other ICU patients without ARDS. Taken together, our findings identify a potentially novel adaptive response of the lung to stretch and a critical role for zinc in defining the lung's tolerance for mechanical ventilation. These results demonstrate that failure of stretch-adaptive responses play an important role in exacerbating mechanical ventilator-induced lung injury, and identify zinc and metallothionein as targets for lung-protective interventions in patients requiring mechanical ventilation.

Serum zinc concentrations correlate with mental and physical status of nursing home residents

INTRODUCTION

Zinc (Zn) is one of the most important trace elements in the body. Zn deficiency seems to play a role in the development of age-related diseases and impairment of quality of life. Zn status has been especially studied in free-living or hospitalised people, but data from older residents of nursing homes are scarce. This study aimed to determine the Zn status among the older individuals in correlation to their mental and physical performance.

METHODS

A total of 100 participants aged between 60-102 years were recruited between October 2010 and May 2012 at the nursing home in Bialystok (Poland). Zn status was evaluated by determining the concentration in serum by flame atomic absorption spectrometry. Anthropometric variables and fitness score (FS) were measured. Abbreviated Mental Test Score (AMTS), Geriatric Depression Scale (GDS), Self-Rated Health (SRH), independence in Activities of Daily Living (ADL) were recorded.

RESULTS AND DISCUSSION

The mean serum Zn concentration was 0.83 ± 0.20 mg/L, 28% of residents had Zn deficiency. Cognitive functions were impaired (AMTS ≤ 8) in 45% of the studied persons and 48% showed depressive symptoms (GDS ≥ 1). The ability to independently perform activities of daily living (ADL = 6) was found in 61% of participants, but most of them (90%) had weak body type (FS < 70), correlating with GDS, SRH and body mass index (BMI). Serum Zn concentration correlated with mental efficiency and was statistically significantly higher in older people with normal cognitive function and without depression than in patients with memory impairment and showing depressive symptoms.

CONCLUSIONS

Nursing home residents seem at risk of marginal Zn status, which correlates with their mental status as measured by the AMTS and GDS. Their low FS is associated with mental health deterioration and obesity.

Impact of zinc metabolism on innate immune function in the setting of sepsis

Individuals at highest risk of zinc deficiency (children, elderly, pregnant and lactating women, morbidly ill, alcoholics) have a higher risk of infection. Whereas the essential role of zinc in maintaining adaptive immunity is well recognized, much less is known regarding the innate immune system. We recently reported that zinc deficiency significantly increases mortality in an animal model of sepsis. In particular, zinc-deficient mice had a decreased capacity to clear bacteria and a concomitant increase in NF-kappaB-mediated signaling across multiple vital organs. This occurred in tandem with exaggeration of the acute phase and innate immune response. Strikingly, sepsis patients revealed similar findings in that lower plasma zinc levels were associated with more inflammation and increased severity of illness. Through these investigations we have consistently observed that SLC39 A8 (ZIP8) is unique, relative to other zinc transporters, in that its expression is significantly induced at the onset of infection. Moreover, induction of ZIP8-mediated zinc transport into innate immune cells is vital for proper immune function. Whether ZIP8 functions beyond the conventional role of a zinc transporter remains a work in progress, although new evidence has revealed that ZIP8 expression itself is regulated by NF-kappaB. Taken together, these findings indicate that zinc is vital for proper innate immune function and that hZIP8 is intricately involved in maintaining innate immune defense.

Zinc modulates the innate immune response in vivo to polymicrobial sepsis through regulation of NF-kappaB

Zinc is an essential element that facilitates coordination of immune activation during the host response to infection. We recently reported that zinc deficiency increases systemic inflammation, vital organ damage, and mortality in a small animal model of sepsis. To investigate potential mechanisms that cause these phenomena, we used the same animal model and observed that zinc deficiency increases bacterial burden and enhances NF-kappaB activity in vital organs including the lung. We conducted further studies in the lung to determine the overall impact of zinc deficiency. At the molecular level, NF-kappaB p65 DNA-binding activity was enhanced by zinc deficiency in response to polymicrobial sepsis. Furthermore, expression of the NF-kappaB-targeted genes IL-1beta, TNFalpha, ICAM-1, and the acute phase response gene SAA1/2 were elevated by zinc deficiency. Unexpectedly, the amount of NF-kappaB p65 mRNA and protein was increased in the lung including alveolar epithelia of zinc-deficient mice. These events occurred with a significant and concomitant increase in caspase-3 activity within 24 h of sepsis onset in zinc-deficient mice relative to control group. Short-term zinc supplementation reversed these effects. Reconstitution of zinc deficiency in lung epithelial cultures resulted in similar findings in response to TNFalpha. Taken together, zinc deficiency systemically enhances the spread of infection and NF-kappaB activation in vivo in response to polymicrobial sepsis, leading to enhanced inflammation, lung injury, and, as reported previously, mortality. Zinc supplementation immediately before initiation of sepsis reversed these effects thereby supporting the plausibility of future studies that explore zinc supplementation strategies to prevent sepsis-mediated morbidity and mortality.

Selenium-dependent glutathione peroxidase activity is increased in healthy post-menopausal women

Selenium helps protect against peroxidation during aging as part of the glutathione peroxidase (GPx) antioxidant system. Selenium status, however, is often low in elderly persons who have low selenium intake, live in institutions, and have certain chronic diseases. In addition, a relationship has been observed between the female reproductive hormone, estrogen, and selenium status, with blood selenium and GPx activity coinciding with fluctuations in estrogen during the menstrual cycle. These findings suggest that the decrease in estrogen following menopause may cause a decrease in selenium status, and thus accelerate the process of aging and increase the risk of certain diseases. The current study compared selenium status in healthy premenopausal (n = 13, 21 to 43 years) and postmenopausal (n = 10, 57 to 86 years) women. Selenium intakes of both groups were similar and greater than the recommended dietary allowance (RDA) of 55 microg/day for adult women. Although neither plasma nor RBC selenium concentrations were significantly different between groups, postmenopausal women had significantly greater plasma (p < 0.02), and RBC (p < 0.05) GPx activities compared to premenopausal women possibly in response to oxidative processes associated with aging. These results indicate that the selenium status of healthy postmenopausal women did not decline with menopause and that their antioxidant capability, as measured by GPx activity, was preserved with dietary intake of selenium greater than the RDA.

Zinc deficiency increases organ damage and mortality in a murine model of polymicrobial sepsis

OBJECTIVE

Zinc deficiency is common among populations at high risk for sepsis mortality, including elderly, alcoholic, and hospitalized patients. Zinc deficiency causes exaggerated inflammatory responses to endotoxin but has not been evaluated during bacterial sepsis. We hypothesized that subacute zinc deficiency would amplify immune responses and oxidant stress during bacterial sepsis {lsqb;i.e., cecal ligation and puncture (CLP){rsqb; resulting in increased mortality and that acute nutritional repletion of zinc would be beneficial.

DESIGN

Prospective, randomized, controlled animal study.

SETTING

University medical center research laboratory.

SUBJECTS

Adult male C57BL/6 mice.

INTERVENTIONS

Ten-week-old, male, C57BL/6 mice were randomized into three dietary groups: 1) control diet, 2) zinc-deficient diet for 3 weeks, and 3) zinc-deficient diet for 3 weeks followed by oral zinc supplementation for 3 days (n = 35 per diet). Mice were then assigned to receive either CLP or sham operation (n = 15 each per diet). CLP and sham-operated treatment groups were further assigned to a 7-day survival study (n = 10 per treatment per diet) or were evaluated at 24 hours (n = 5 per treatment per diet) for signs of vital organ damage.

MEASUREMENTS AND MAIN RESULTS

Sepsis mortality was significantly increased with zinc deficiency (90% vs. 30% on control diet). Zinc-deficient animals subject to CLP had higher plasma cytokines, more severe organ injury, including increased oxidative tissue damage and cell death, particularly in the lungs and spleen. None of the sham-operated animals died or developed signs of organ damage. Zinc supplementation normalized the inflammatory response, greatly diminished tissue damage, and significantly reduced mortality.

CONCLUSIONS

Subacute zinc deficiency significantly increases systemic inflammation, organ damage, and mortality in a murine polymicrobial sepsis model. Short-term zinc repletion provides significant, but incomplete protection despite normalization of inflammatory and organ damage indices.

Serum zinc and copper status in hospitalized vs. healthy elderly subjects

OBJECTIVE

To assess serum zinc and copper concentrations of elderly hospitalized patients with a broad range of diseases and compare their levels to those of healthy community dwelling controls of similar age.

METHODS

This case-control study compared serum zinc and copper levels of 668 hospitalized subjects, aged 70 or over, with 104 healthy controls of the same age and from the same geographical area. The study protocol, conducted by one physician on the day after the admission to the hospital, included a questionnaire on sociodemographic characteristics, a medical examination, and serum zinc and copper measured with flame atomic absorption spectrophotometry. Data were analysed using analysis of covariance, controlling for age and sex.

RESULTS

The diseased subjects had markedly lower zinc concentrations than the control group. The frequency of low values (<0.70 mg/L) was high (20.2% vs. zero in controls, p < 0.001), and it differed among various disease categories: 35.7% for respiratory disease, 20%- 27% for cancer, infectious disease, trauma, blood diseases, and genitourinary diseases, and less than 20% for the other diseases. Low values for serum copper concentration (<0.80 mg/L) were rare in hospitalized subjects (1.4% vs. zero in controls). Whatever the disease category and number of diagnoses considered, the serum copper/zinc ratio was significantly (p < 0.001) higher in diseased than in healthy people.

CONCLUSIONS

Elderly hospitalized patients are at elevated risk of low zinc but not copper values. The significantly lower values of serum zinc found in the hospitalized elderly compared to healthy elderly are likely to be related to disease rather than to aging per se. In addition to other classic anthropometric (BMI) and biological (serum proteins) nutritional parameters, copper/zinc ratio may be a useful marker of malnutrition.

Serum zinc and pneumonia in nursing home elderly

BACKGROUND

Zinc plays an important role in immune function. The association between serum zinc and pneumonia in the elderly has not been studied.

OBJECTIVE

The objective was to determine whether serum zinc concentrations in nursing home elderly are associated with the incidence and duration of pneumonia, total and duration of antibiotic use, and pneumonia-associated and all-cause mortality.

DESIGN

This observational study was conducted in residents from 33 nursing homes in Boston, MA, who participated in a 1-y randomized, double-blind, and placebo-controlled vitamin E supplementation trial; all were given daily doses of 50% of the recommended dietary allowance of essential vitamins and minerals, including zinc. Participants with baseline (n = 578) or final (n = 420) serum zinc concentrations were categorized as having low (<70 microg/dL) or normal (>or=70 microg/dL) serum zinc concentrations. Outcome measures included the incidence and number of days with pneumonia, number of new antibiotic prescriptions, days of antibiotic use, death due to pneumonia, and all-cause mortality.

RESULTS

Compared with subjects with low zinc concentrations, subjects with normal final serum zinc concentrations had a lower incidence of pneumonia, fewer (by almost 50%) new antibiotic prescriptions, a shorter duration of pneumonia, and fewer days of antibiotic use (3.9 d compared with 2.6 d) (P <or= 0.004 for all). Normal baseline serum zinc concentrations were associated with a reduction in all-cause mortality (P = 0.049).

CONCLUSION

Normal serum zinc concentrations in nursing home elderly are associated with a decreased incidence and duration of pneumonia, a decreased number of new antibiotic prescriptions, and a decrease in the days of antibiotic use. Zinc supplementation to maintain normal serum zinc concentrations in the elderly may help reduce the incidence of pneumonia and associated morbidity.

Effect of zinc supplementation on vitamin status of middle-aged and older European adults: the ZENITH study

OBJECTIVE

To assess the effects of zinc supplementation on vitamin status in middle-aged and older volunteers.

SUBJECTS/METHODS

Three hundred and eighty-seven healthy middle-aged (55-70 years) and older (70-85 years) men and women, randomly allocated to three groups to receive 15 or 30 mg Zn/day or placebo for 6 months. Dietary intake was assessed by means of a validated 4-day recall record. Fasting blood samples were simultaneously analysed for levels of plasma retinol and alpha-tocopherol by high-performance liquid chromatography. Erythrocyte folates were measured by a competitive immunoassay with direct chemiluminescence detection on an automatized immunoanalyser. Biochemical measurements were performed at baseline and after 3 and 6 months of zinc supplementation.

RESULTS

Plasma vitamin A levels were significantly increased proportionally with zinc dose and period of treatment, particularly at 6 months (for 15 mg Zn/day, P<0.05; for 30 mg Zn/day, P<0.0001); no significant changes were observed in the placebo group. There was no effect of zinc supplementation on vitamin E/cholesterol ratio and erythrocyte folates.

CONCLUSIONS

Our results show that a long-term zinc supplementation increases plasma vitamin A levels in middle-aged and older people of similar characteristics to those involved in this study. Moreover, supplementation influences serum zinc levels but does not affect erythrocyte zinc concentration and both plasma vitamin E and erythrocyte folate status.

Age- and sex-dependent effects of long-term zinc supplementation on essential trace element status and lipid metabolism in European subjects: the Zenith Study

Given the key role of Zn in many physiological functions, optimal Zn status could be a predictive parameter of successful ageing. However, the benefit of Zn supplementation is still a matter of debate since Zn supplementation has been reported to be associated with the alteration of Cu status and lipid metabolism. As part of the Zenith Project, the present study aimed to investigate, in free-living healthy European middle-aged and older subjects, the effect of Zn supplementation on the biochemical status of Zn, Fe and Cu and on lipid profile. Volunteers aged 55–70 (n188) and 70–85 (n199) years old participated in a double-blinded, randomised study and received a daily placebo, or Zn as 15 or 30 mg for 6 months. Zn supplementation did not significantly modify erythrocyte Zn levels or erythrocyte Cu,Zn-superoxide dismutase activity. But Zn supplementation at 15 or 30 mg/d for 6 months increased significantly serum Zn levels and Zn urinary excretion with no major adverse effects on Fe and Cu status or on lipid metabolism. However, Zn supplementation at 30 mg/d showed some age- and sex-dependent alterations in Fe status or lipid profile. Therefore, with respect to the key role of an optimal Zn status in successful ageing, Zn supplementation at 15 mg/d, when necessary, could be safely proposed regarding lipids and the risk of interaction with Fe and Cu.

Effect of Multivitamin and Mineral Supplementation on Episodes of Infection in Nursing Home Residents: A Randomized, Placebo-Controlled Study

OBJECTIVES

To evaluate the effect of vitamin and mineral supplementation on infections in an elderly institutionalized population.

DESIGN

Eighteen-month, randomized, placebo-controlled trial.

SETTING

Twenty-one long-term care facilities.

PARTICIPANTS

Seven hundred sixty-three subjects from 21 long-term care facilities.

INTERVENTION

Participants were randomized to receive one multivitamin and mineral supplementation daily or placebo.

MEASUREMENTS

The primary outcome was number of infections per subject. Secondary outcomes were antibiotic use and hospitalization rates. Infection control surveillance was conducted over 18 months using standardized criteria.

RESULTS

Outcome data from 748 subjects, mean age 85, were included in the intention-to-treat analysis. Using univariate analyses, there was no difference in infectious episodes between the supplemented and placebo groups (3.5 infections per 1,000 resident-days vs 3.8 infections per 1,000 resident-days, odds ratio (OR)=0.92, 95% confidence interval (CI)=0.82-1.03, P=.12). There was a reduction in antibiotic usage in the supplementation group, but this was not significant in the multivariate model. There was no difference in the number of hospital visits. In the multivariate analysis, the effect of multivitamin use on total number of infections was not significant (OR=0.77, 95% CI=0.54-1.1). Subjects without dementia had a greater rate of infections than those with dementia (OR=1.44, 95% CI=1.19-1.76). In post hoc subgroup analysis, subjects without dementia who received supplementation had a significantly lower rate of infections than those who received placebo (relative risk=0.81, 95% CI=0.66-0.99).

CONCLUSION

Overall, multivitamin and mineral supplementation does not have a significant effect on the incidence of infections in institutionalized seniors, although the subgroup of residents in long-term care without dementia may benefit from supplementation. Further research is needed to determine its effect in high-risk subgroups within the nursing home population.

Factors associated with longitudinal plasma selenium decline in the elderly: the EVA study

Selenium status decreases in elderly populations. Cardiovascular diseases are the primary cause of death in the French elderly, and selenium may protect against cardiovascular diseases. The present work aims to evaluate the relationships between cardiovascular-related risk factors and plasma selenium variability in an elderly population during a 9-year period. Seven hundred fifty-one subjects from the EVA ("Etude du Vieillissement Artériel") study, aged 59 to 71 at baseline, were followed for 9 years. Clinical examinations and lifestyle questionnaires were repeated every 2 years. Plasma selenium determinations were performed at baseline and at the end of the study. The association between the 9-year plasma selenium variability and studied risk factors at baseline or occurring during the follow-up was evaluated by using multivariate linear regression models. After controlling all potential associated factors, age of subjects (P<.01), obesity (P=.02) and occurrence of cardiovascular disease during follow-up (P=.03) increased the longitudinal decline in plasma selenium, whereas gender, education, smoking, alcohol intakes, dyslipidemia, diabetes, hypertension had no effect (P>.05). It may be postulated that obesity and occurrence of cardiovascular events are the main factors associated with plasma selenium fall during ageing. The respective roles played by nutritional and metabolism changes in the mechanism of these associations still need to be explored.

Zinc intake and status in middle-aged and older European subjects: the ZENITH study

OBJECTIVE

Inadequate intakes of micronutrients in elderly negatively affect the nutritional status. Zinc is an essential micronutrient in the elderly, especially in relation to its impact on immune function, bone mass, cognitive function and oxidative stress. However, data are lacking on zinc intake and status during normal ageing. In this study, we evaluate the intake and status of zinc in late middle-aged and older free-living subjects.

DESIGN

Dietary zinc intake and zinc status in 188 middle-aged subjects from Clermont-Ferrand (Fr) and Coleraine (UK), and in 199 older subjects from Grenoble (Fr) and Roma (It) were assessed at the entry in the ZENITH study.

RESULTS

In relation to the zinc RDA for people older than 55 y, zinc intakes in most of the middle-aged and older subjects (more than 96%) in the present study were adequate. Older people had significantly lower (P < 0.01) energy intakes as compared to middle-aged. Zinc intake expressed per MJ was also significantly (P < 0.01) higher in older people compared to middle-aged. Erythrocyte and urinary zinc concentrations were significantly (P < 0.001) higher in middle-aged subjects compared to older ones. The prevalence of biological Zn deficiency in free-living ageing European people was low (<5%).

CONCLUSION

The results of the present study showed a relatively low prevalence of zinc deficiencies in healthy free-living late middle-age and older subjects. These results should be useful for health professionals to have reference data on zinc intake and status for a healthy ageing.

Influence of Short-Chain Fructo-Oligosaccharides (sc-FOS) on Absorption of Cu, Zn, and Se in Healthy Postmenopausal Women

OBJECTIVE

This study was carried out to evaluate the effect of short-chain fructooligosaccharides (sc-FOS) on the absorption of Cu, Zn, and Se among postmenopausal women who are potential candidates to subclinical trace element deficiencies.

DESIGN

A randomized double blind cross-over study.

SETTING

This study was carried out at the Human Nutrition Research Center, Clermont-Ferrand, France.

SUBJECTS

11 postmenopausal women aged 53-70 y, not taking hormone replacement therapy were enrolled and completed the study.

INTERVENTIONS

Diets with 10 g/day sc-FOS or placebo were given for 5 weeks each in random order followed by a wash-out period of at least 3 weeks. At the end of each period, stable isotopes (3.19 mg 67Zn as ZnCl2, 2.06 mg 65Cu as CuCl2 and 52.3 microg 74Se as sodium selenite) and radiopaque pellets (as fecal excretion index) were administered during lunch. Stools were collected for the next 5-7 days. Isotopes were determined by ICP-MS (Cu and Zn) or GC-MS (Se).

RESULTS

Copper absorption was significantly enhanced (p = 0.042) by sc-FOS. No effect of sc-FOS was observed on Zn, and Se absorption.

CONCLUSION

To our knowledge, this is the first study on the influence of sc-FOS on trace element metabolism. The observed increase in copper absorption may be of interest regarding daily copper requirements in menopausal women. However, the relevance of this observation remains to be established.

Biochemical antioxidant levels respond to supplementation with an enriched drink in frail elderly people

OBJECTIVE

To investigate whether a drink enriched with essential vitamins and minerals can improve biochemical status of enzymatic and non-enzymatic antioxidants in frail elderly people.

METHODS

A six-month randomized, double blind, placebo controlled intervention study. Frail elderly people 65 years of age or older, with a body mass index (BMI) below 25 kg/m(2) and residing in a home for the elderly or in sheltered housing. Enriched (with essential vitamins and minerals in 30% to 150% of RDA and higher levels of antioxidants) drink (n = 28) or placebo (n = 27) to be taken twice a day in addition to the normal food consumed. Plasma levels of vitamin C, vitamin E, antioxidant capacity (TEAC), cysteine, uric acid and whole blood levels of total thiol and glutathione peroxidase (GSH-Px), dietary intake.

RESULTS

Changes in vitamin E (16 +/- 2 vs. 2 +/- 1 mmol/L), vitamin C (37 +/- 5 vs. 1 +/- 5 mmol/L), TEAC (38 +/- 15 vs. -10 +/- 11 mmol/L Trolox eq) and cysteine (17 +/- 10 vs. 0.4 +/- 6 mmol/L) were significantly different between groups (p < 0.05). There was a trend towards significant changes in erythrocyte glutathione peroxidase (-0.2 +/- 3 vs. -10 +/- 7 U/mg Hb, p = 0.097). Baseline dietary intake of antioxidant vitamins was below 2/3 RDA for a substantial proportion (43% to 76%) of subjects.

CONCLUSIONS

Supplementation with an enriched drink can raise plasma levels of enzymatic and non-enzymatic antioxidants in frail elderly people.

Prevalence of zinc deficiency and its clinical relevance among hospitalised elderly

Zinc is an essential trace element, and constituent of many metallo-enzymes required for normal metabolism. Age may be associated with altered metallothionein metabolism related to changes in zinc metabolism. The objectives of this study were: (i) to assess the prevalence of zinc deficiency among hospitalised elderly patients; (ii) to define the social, functional, pathological and nutritional characteristics of zinc deficient elderly hospitalised patients; and (iii) to assess the relationship between the zinc status and humoral immune function among hospitalised elderly patients. Fifty consecutive patients underwent comprehensive geriatric assessments included evaluations of the medical (index of the severity of the disease(s)), psychiatric (Geriatric depression scale (GDS)), therapeutic, social, functional (Katz's scale), and nutritional problems (Mini Nutritional Assessment (MNA) and biochemical markers (zinc, albumin, prealbumin (PAB), cholesterol) before their discharge. Fourteen patients (28%) presented a zinc concentrations lower than 10.7 micromol/l, this value is usually considered as the cut-off level below which a zinc deficient status is possible. Higher proportions of respiratory infections, cardiac failure, and depression were observed among zinc deficient patients as compared with the group of patients with normal zinc status. The other parameters of comprehensive geriatric assessment did not allow to discriminate the zinc deficient patients. The only slight differences (which remained unsignificant) concerned the prealbumin levels which tended to be higher in the group of patients presenting normal zinc status than in the group with poor zinc status (0.208+/-0.062 versus 0.171+/-0.068 g/l respectively, P=0.06), and the IgG2 levels which tended to be lower in the group of patients with normal zinc status than in the group presenting poor zinc status (2.77+/-1.91 versus 4.06+/-2.56, respectively, P=0.057). A negative correlation was observed between the Zn concentrations and the IgG2 levels (Spearman R=-0.311, P=0.028). To the best of our knowledge, this is the first study presenting zinc status according to a comprehensive geriatric assessment among European hospitalised geriatric patients. We decided to perform this study to known whom of our patients needed to be supplemented with zinc administration. Considering the low energy intake of hospitalised patients (confirmed here in regards of the nutritional assessment), and the insufficient trace element density in European foods, the relevance of providing medical supplements or enriched foods to this population has to be evaluated. Although most of the current diseases may be relevant to long-term interactions between nutrition and ageing, certain states observed in the elderly, like impaired immune and cognitive functions, could still benefit from an appropriate nutritional supplementation.

Selenium and zinc status are suboptimal in a sample of older New Zealand women in a community-based study

The importance of selenium and zinc in the immune functioning of the aged is widely recognized. Seniors in New Zealand are at particularly high risk of low selenium status because of the low selenium soil environment. The zinc status of the New Zealand elderly has never been assessed. In this cross-sectional study, the biochemical selenium, zinc and lipid levels, physical functional capacity and dietary intakes of 103 randomly selected free-living New Zealand women (mean age +/- SD, 75 +/- 3 y) were assessed. Among nonusers of selenium supplements (n = 80), 80% [95% confidence interval (CI): 70; 88%] had plasma selenium levels (0.85 +/- 0.23 micromol/L) below 1.00 micromol/L [ approximately 10% below mean plasma selenium necessary for full expression of glutathione peroxidase (GPx) activity in New Zealand subjects]. Plasma selenium was strongly correlated with GPx: r = 0.56; P < 0.0001. For nonusers of zinc supplements (n = 88), serum zinc concentrations were 12.4 +/- 1.4 micromol/L, with 12% (95% CI: 6; 21%) having levels below the cut-off value (10.7 micromol/L). Estimated mean daily selenium and zinc intakes were 34 +/- 10 microg and 8.7 +/- 2.0 mg, respectively. Subjects in the highest tertile of a functional capacity index had higher biochemical zinc and selenium values than those in the lowest tertile (P < 0.05). The correlation between plasma selenium and GPx indicates that selenium intake in these women is still insufficient for full expression of GPx activity. Lower serum zinc levels also appear to be prevalent. Because a suboptimal trace element status may be more common among those with a poor physical functioning, promotion of the consumption of nutrient dense foods or supplements to improve selenium and zinc status of elderly women in New Zealand may be beneficial.

Micronutrient status and glutathione peroxidase in bedridden patients on tube feeding

Deficiency of micronutrients, especially selenium, is common in critically ill patients. We investigated the micronutrient status (selenium, zinc, copper and manganese) and glutathione peroxidase (GSH-Px) activity in 30 tube-fed patients and 21 hospitalized non-tube-fed control patients. Serum levels of selenium, copper and manganese in tube-fed patients were significantly lower than in control patients (selenium: 4.85+/-1.38 microg/dl versus 8.67+/-1.45 pg/dl; copper: 44.7+/-36.9 microg/dl versus 92.1+/-21.2 microg/dl; manganese 0.59+/-0.41 microg/dl versus 1.52+/-0.59 microg/dl). However, zinc and log GSH-Px in the serum were similar in the two groups. Serum selenium concentration correlated with the daily intake of selenium in tube-fed patients, but zinc, copper and manganese concentrations did not correlate with the daily intake of the respective trace elements in tube-fed patients. Blood GSH-Px activity correlated positively with serum selenium concentrations in the control patients, but not in tube-fed patients. These results demonstrate that selenium content of enteral feed appears to be insufficient to maintain normal serum levels in elderly bedridden patients. Our findings emphasize the importance of monitoring micronutrient status in patients on enteral feeding to avoid trace element deficiencies.

Micronutrients and ageing: intakes and requirements

Ageing (and related diseases) may be described as a process which results from impaired immunological, genetic, neurological or endocrinological functions. Oxidative mechanisms may play an important role in the ageing process. It is important, therefore, to emphasize the relationship between health and nutrition in the elderly, particularly with regard to antioxidant micronutrient requirements. Indeed, accelerated ageing may be related to a deficit in the intakes of antioxidant vitamins (tocopherols, carotenoids and vitamin C) and trace elements (Zn and Se), as well as to an impaired adaptative mechanism against oxidative stress. Physiological modifications occurring during the lifetime and environmental influences are significant factors contributing to the impairment of micronutrient status, and these factors have to be considered when defining the specific requirements of the elderly. For Fe there is no evidence of benefit of supplementation in healthy subjects, but in the present state of knowledge combined supplementation, including Zn, Se, vitamins C and E and carotenoids, could be the best way to prevent accelerated ageing and reduce the risk of several common age-related diseases.

Fatty acid nutriture in hospitalized elderly women

OBJECTIVE

The aim of this study was to measure the fatty acid (FA) dietary intakes and the FA composition of plasma total lipids in a selected group of hospitalized elderly patients.

METHODS

Twenty-three women aged 76 to 99 years were recruited. FA were analyzed in 5-day duplicate portions and in plasma by gas liquid chromatography.

RESULTS

The hospitalized elderly women ingested an average of 5.22 megajoules (MJ) and 45.9 g of lipids per day. Polyunsaturated fatty acids (PUFA) represented 11.0% and saturated fatty acids (SFA) 53.6% of the lipid intake. Minimal recommendations for linoleic acid intake were reached in average, but 32% of the patients ingested less than 3 g of linoleic acid/d. Eighty-six percent received less than 0.5% of energy for alpha-linolenic acid and 64% had low intakes in very long-chain n-3 FA. In parallel, these patients presented several biochemical signs of essential fatty acids (EFA) insufficiency (decrease in linoleic acid, increase in monounsaturated fatty acids (MUFA), in n-7 FA and in indexes of delta-6 and delta-9 desaturase activities).

CONCLUSIONS

Hospitalized elderly patients have low PUFA intakes and show biochemical indices of EFA insufficiency. These patients might benefit from a nutritional supplementation providing both EFA and antioxidant micronutrients to limit the risk of skin troubles, immune system impairment and vascular disease often observed in institutionalized elderly subjects.

Copper/zinc ratio and systemic oxidant load: effect of aging and aging-related degenerative diseases

There is evidence that copper and zinc have pro-oxidant and antioxidant properties, respectively, so that their imbalance may be expected to condition oxidative stress status. Oxidative stress is relevant in aging and in age-related degenerative diseases. In this study, blood content of copper, zinc, and ceruloplasmin as well as of lipid peroxides were investigated in 81 healthy and 62 disabled octo-nonagenarians affected by chronic degenerative diseases, and in 81 healthy adults. Serum copper/zinc ratio and ceruloplasmin were significantly higher in the elderly than in the healthy adults. Moreover, all these parameters were significantly higher in the disabled than in the healthy elderly. Notably, the increased copper/zinc ratio found in healthy elderly was due to high copper values, whereas in the disabled, both high copper and low serum zinc concentrations were present. The copper/zinc ratio was significantly and positively related to systemic oxidative stress status in all groups. The higher the serum copper/zinc ratio the higher the lipid peroxides plasma content. We conclude that there is a strict relationship between copper/zinc ratio and systemic oxidant burden. Moreover, advanced age and, particularly, advanced age-related chronic degenerative diseases are associated with a significant increase in the copper/zinc ratio and systemic oxidative stress.