Effects of a diet low in copper on copper-status indicators in postmenopausal women

Copper and Melanoma Risk: Results from NHANES 2007-2018 and Mendelian Randomization Analyses

Copper is an essential trace element obtained from food. There is a paucity of observational or prospective studies that have investigated the relationship between copper and melanoma risk. Copper serves as a cofactor for pivotal enzymes involved in mitochondrial respiration, antioxidant defense, and neurotransmitter synthesis. Undoubtedly, copper plays an indispensable role in the initiation and progression of tumors, particularly melanoma; however, further investigations are warranted to elucidate the underlying mechanisms linking copper and melanoma risk. Given the availability of dietary copper and serum copper data in the NHANES database, we conducted an investigation into the association between dietary copper intake and serum copper levels with melanoma risk. We enrolled 26,401 individuals with dietary copper data in the 2007-2018 NHANES database. To mitigate confounding variables, a propensity score matching (PSM) was performed. To assess the association between dietary copper intake and melanoma risk, we employed a multivariate logistic regression analysis before and after PSM. The restricted cubic spline analysis was utilized to determine whether there is a non-linear relationship between dietary copper intake and melanoma risk, with subgroup analysis conducted to determine beneficiaries. Then, those with blood copper data from the enrolled population with dietary copper intake were screened out, and subsequently, multivariate logistic regression models were subsequently constructed to investigate the association between serum copper levels and melanoma risk after PSM. Mendelian analysis was further utilized to validate the results of the NHANES database using serum copper as the exposure factor and melanoma as the outcome variable. The study found that melanoma risk was associated with dietary copper intake before and after PSM, demonstrated by multiple logistic regression. The relationship between dietary copper intake and melanoma risk was non-linear, with a reduced risk observed above approximately 2.5 mg/day, as shown by the RCS. The evidence suggests that an increased intake of copper is linked to a decreased risk of melanoma. To clarify the mechanism behind the increased risk of melanoma due to higher dietary copper intake, we analyzed the population data from the NHANES database on serum copper and dietary copper intake. Our results indicated that there is no causal relationship between serum copper and melanoma risk. Mendelian randomization analysis of multi-database data sources confirmed the conclusion of the NHANES database analysis. Dietary copper is a protective factor against melanoma, and serum copper or blood copper is not associated with melanoma risk. This suggests that serum or blood copper is not responsible for the protective effect of dietary copper intake on melanoma risk, and the mechanisms need to be further investigated.

Assessment of coagulation markers, serum zinc and copper in children with beta-thalassemia major in Egypt

BACKGROUND

Thalassemia is one of the commonest single gene disorders usually associated with many complications. Coagulation changes as well as trace elements levels alterations have been described in children with β thalassemia. Activation of coagulation can be assessed by measuring thrombin-antithrombin (TAT) complex, plasmin-antiplasmin (PAP) complex and β-thromboglobulin (β-TG).

METHODS

A total of 200 children and adolescents were enrolled in the study; 100 were from the Al-Azhar University hospital's pediatric hematology clinic diagnosed as thalassemia major, while the other 100 were apparently healthy volunteers who acted as the control group. Complete blood count, liver function test, kidney function tests, TAT complex, PAP complex, β-TG as indicators of coagulation changes, serum zinc and copper were performed on all participants.

RESULTS

Significantly higher levels of TAT complex, PAP complex and β-TG in thalassemia children than the controls. Decreased serum zinc and increased serum copper levels in thalassemia children compared to the controls. A negative correlation was observed between the serum level of TAT and hemoglobin level, besides the negative correlation of TAT complex and β-TG with the serum zinc.

CONCLUSION

Thalassemia major was associated with increased serum level of coagulation activation markers, increased serum copper while decreased serum zinc.

Association of Zinc and Copper Status with Cardiovascular Diseases and their Assessment Methods: A Review Study

Cardiovascular disease (CVD) is the leading cause of mortality, morbidity, and financial losses and has a high prevalence across the world. Several studies have investigated the association between various CVD types with zinc and copper status as the essential minerals for the human body, proposing contradictory and similar results. This narrative review aimed to survey the correlations between zinc and copper status in the human body and some risk factors of CVD, as well as the assessment methods of zinc and copper status in the human body. According to the reviewed articles, zinc and copper deficiency may increase the risk of coronary heart disease, valvular regurgitation, and myocardial lesions, cardiac hypertrophy. Furthermore, it could lead to the expanded mitochondrial compartments of the heart, acute and chronic heart failure, and elevation of inflammation markers, such as interleukin-1 (IL-1) and IL-6. Two methods are primarily used for the assessment of zinc and copper in the human body, including the direct method (measurement of their concentrations) and indirect method (determining the activity of zinc- and copper-containing enzymes). Both these methods are considered reliable for the assessment of the zinc and copper levels in healthy individuals. Serum or plasma levels of these elements are also commonly used for the assessment of the correlation between zinc and copper status and CVD. But, which one is a more accurate indicator in relation to CVD is not yet clear; therefore, further studies are required in this field.

Copper nutrition and biochemistry and human (patho)physiology

The essential trace mineral copper plays important roles in human physiology and pathophysiology. Disruption of copper homeostasis may underlie the development of ischemic heart disease, and connective tissue and neurodegenerative disorders. Copper also likely participates in the host response to bacterial infection and is further implicated more broadly in regulating immunity. Recent studies further associate copper with disruption of lipid homeostasis, as is frequently seen in, for example, non-alcoholic fatty liver disease (NAFLD). Moreover, continuing investigation of copper chaperones has revealed new roles for these intracellular copper-binding proteins. Despite these (and many other) significant advances, many questions related to copper biology remain unanswered. For example, what are the most sensitive and specific biomarkers of copper status, and which ones are useful in marginal (or "sub-clinical" copper deficiency)? Further research on this topic is required to inform future investigations of copper metabolism in humans (so the copper status of study participants can be fully appreciated). Also, are current recommendations for copper intake adequate? Recent studies suggest that overt copper deficiency is more common than once thought, and further, some have suggested that the copper RDAs for adults may be too low. Additional human balance and interventional studies are necessary and could provide the impetus for reconsidering the copper RDAs in the future. These and myriad other unresolved aspects of copper nutrition will undoubtedly be the focus of future investigation.

Elevated plasma factor VIII levels in a mixed patient population on anticoagulation and past venous thrombosis

BACKGROUND

Thrombophilia conditions are associated with an increased risk of venous thromboembolism. Elevated plasma levels of factor VIII (>150 IU/dL) increase the risk of venous thrombosis. The aim of this report is to analyze a subset of patients in whom plasma factor VIII levels were investigated as part of a thrombophilia panel at a specialty venous clinic at a tertiary care hospital.

METHODS

From January 2019 to December 2019, records of all patients (n = 306) who had a plasma factor VIII level assay performed as part of a thrombophilia panel were retrospectively analyzed. Group 1 (n = 92) had normal factor VIII levels (≤150 IU/dL), whereas group 2 (n = 214) had elevated factor VIII levels (>150 IU/dL). Venous thromboembolic events were classified as provoked if there was an association with surgery, trauma, immobilization, orthopedic fracture, peripartum period, or use of hormones. If there was no associated factor identifiable in the patient's history, the event was considered unprovoked.

RESULTS

The median age for patients in groups 1 and 2 was 55 and 65 years, respectively. Family history of deep venous thrombosis (DVT) was noted in 6 patients in group 1 (6.5%) vs 77 patients in group 2 (36%), P value: .0001. Unprovoked DVT was more commonly noted in group 2 patients (66%) compared with group 1 patients (5%), P value: .0001. In addition, venous ulceration was more commonly encountered in group 2 (23%) than group 1 (11%), P value: .008. Factor VIII level >150 IU/dL was a significant predictor of DVT occurrence itself (odds ratio: 3.3, P value <.005). Factor VIII level >200 IU/dL was a significant predictor of occurrence of two or more episodes of DVT (odds ratio: 12.3, P value < .005).

CONCLUSIONS

Factor VIII levels were found to be elevated in a significant proportion of patients in whom thrombophilia testing was performed at a specialty venous clinic. This elevation was more common in patients with venous ulceration, a positive family history of DVT, and a personal history of an unprovoked DVT. Levels above 200 IU/dL were associated with DVT recurrence. This has important implications for secondary prophylactic strategies for DVT.

Exposure risk of local residents to copper near the largest flash copper smelter in China

Copper (Cu) smelting released large amounts of Cu and contaminated the environment. However, few studies have investigated the Cu exposure risks for people located near Cu smelters. In this study, atmospheric bulk deposition, food from local families, drinking water and biological samples (hair and urine) were collected in three villages near the largest flash Cu smelter in China. The objective of the current study was to investigate how non-ferrous metals smelting affect the human health. Total atmospheric Cu depositions (56-767μgm^-2yr^-1) were one or two orders of magnitude greater than that of unpolluted rural areas. The Cu concentrations in locally grown vegetables and dietary chronic daily intake (CDI) of local residents showed a consistently decreasing trend with atmospheric Cu depositions. Dietary intake of vegetables and rice were the two major pathways of total CDI, which accounted for >93% totally. The Cu exposure showed higher potential non-carcinogenic risk to human health of local residents, especially children living around the Cu smelter through food consumptions. Health impact monitoring data revealed that mean Cu concentrations in hair and urine samples were ranged from 5.13 to 28.85mgkg^-1 and 19.90 to 54.61μgL^-1 in the three villages, respectively. Significant correlation between hair Cu concentrations and the CDI of Cu indicated food ingestion had adverse effects on the health of the local residents. The result suggested that nonferrous metal smelter should be away from residential area and locally produced crops became unsuitable for consumption. Therefore, effective measures on Cu pollution management and control in the surrounding area should be formulated and implemented.

Trace Elements and Healthcare: A Bioinformatics Perspective

Biological trace elements are essential for human health. Imbalance in trace element metabolism and homeostasis may play an important role in a variety of diseases and disorders. While the majority of previous researches focused on experimental verification of genes involved in trace element metabolism and those encoding trace element-dependent proteins, bioinformatics study on trace elements is relatively rare and still at the starting stage. This chapter offers an overview of recent progress in bioinformatics analyses of trace element utilization, metabolism, and function, especially comparative genomics of several important metals. The relationship between individual elements and several diseases based on recent large-scale systematic studies such as genome-wide association studies and case-control studies is discussed. Lastly, developments of ionomics and its recent application in human health are also introduced.

Disconnect Between Genes Associated With Ischemic Heart Disease and Targets of Ischemic Heart Disease Treatments

Background

Development of pharmacological treatments to mitigate ischemic heart disease (IHD) has encompassed disappointing results and expensive failures, which has discouraged investment in new approaches to prevention and control. New treatments are most likely to be successful if they act on genetically validated targets. We assessed whether existing pharmacological treatments for IHD reduction are acting on genetically validated targets and whether all such targets for IHD are currently being exploited.

Methods

Genes associated with IHD were obtained from the loci of single nucleotide polymorphisms reported in either of two recent genome wide association studies supplemented by a gene-based analysis (accounting for linkage disequilibrium) of CARDIoGRAMplusC4D 1000 Genomes, a large IHD case (n = 60,801)-control (n = 123,504) study. Treatments targeting the products of these IHD genes and genes with products targeted by current IHD treatments were obtained from Kyoto Encyclopedia of Genes and Genomes and Drugbank. Cohen's kappa was used to assess agreement.

Results

We identified 173 autosomal genes associated with IHD and 236 autosomal genes with products targeted by current IHD treatments, only 8 genes (PCSK9, EDNRA, PLG, LPL, CXCL12, LRP1, CETP and ADORA2A) overlapped, i.e. were both associated with IHD and had products targeted by current IHD treatments. The Cohen's kappa was 0.03. Interventions related to another 29 IHD genes exist, including dietary factors, environmental exposures and existing treatments for other indications.

Conclusions

Closer alignment of IHD treatments with genetically validated physiological targets may represent a major opportunity for combating a leading cause of global morbidity and mortality through repurposing existing interventions.

•

Pharmacological treatments for ischemic heart disease (IHD) target < 5% (8/173) of genes strongly predicting IHD.

•

Treatments or nutraceuticals targeting products of another 17% (29/173) of genes strongly predicting IHD exist.

•

Repurposing represents a major opportunity to prevent and treat a leading cause of global morbidity and mortality.

Development of drugs to mitigate ischemic heart disease, a leading cause of global morbidity and mortality, has stalled. We examined the relation between the physiological targets of current drugs for ischemic heart disease and the genetic predictors of ischemic heart disease. We found little correspondence between the genes with products targeted by current ischemic heart disease drugs and the genes associated with ischemic heart disease, but found several drugs for other purposes relevant to ischemic heart disease genes. Refocusing ischemic heart disease drug development on genetically valid targets and repurposing existing drugs represents a major opportunity to improve population health.

Comparison of the effect of dietary copper nanoparticles with copper (II) salt on bone geometric and structural parameters as well as material characteristics in a rat model

Copper is required for normal functioning of all basic biochemical and physiological processes in the body. The objective of this study was to compare the effect of two different chemical forms (carbonate and nanoparticles) of Cu administered in feed mixtures to growing rats on bone geometric and structural parameters as well as material characteristics in a rat model. For this purpose, five experimental treatments were used to evaluate the effects of different levels of Cu applied in the diet as a mineral mixture (the standard dose of 6.5mg/kg diet, half the standard dose, and no Cu in mineral mixture as a negative control) and two Cu sources (CuCO₃ - commonly used in rodent laboratory diets and a Cu-NP nanoparticle preparation, 40nm). There were no changes in body weight and bone morphology, but significant alteration was noted in the geometry and mechanical parameters, which was Cu-NP-dose dependent. Our study showed an increase in the ultimate load and toughness in Cu-NP-treated rats at the standard concentration. The higher values of the studied parameters prove that there was a change in bone mineralization. Although bone mineral density and content were not changed, bone tissue density and ash increased. The XRD analysis revealed that some peaks did not originate from hydroxyapatite, and they indicated existence of other mineral phases. No studies conducted so far have provided a detailed mechanical X-ray diffraction analysis of bone tissue of growing rats administered with diet containing Cu nanoparticles. This study showed that Cu-NP given in low dose increased mechanical endurance of bone, without the changes in strain and stress compared to low dose of Cu given in traditional form.

The Influence of the Dietary Cu-Glycine Complex on the Histomorphology of Cancellous Bone, Articular Cartilage, and Growth Plate as well as Bone Mechanical and Geometric Parameters Is Dose Dependent

Copper (Cu) is required for all basic biochemical and physiological processes. The objective of this study was to compare the effect of two different chemical forms (sulfates and glycinate chelates also below the recommended dose) of Cu administered to adult rats on the biomechanical and morphometric properties of femur. Male rats at the age of 12 weeks were used in the 12-week experiment. The control diet provided the required Cu level from sulfate (S-Cu), and the other diets were supplemented with Cu-glycine complex. The Cu-Gly-treatment, irrespective of its concentration, did not influence the bone mass and length. The Cu-Gly-treatment in 100 and 75% of daily demand increased mechanical endurance. The Cu-Gly-treatment (regardless of its concentration) increased the real bone volume in epiphysis and decreased the total thickness and zone I of the articular cartilage compared to the control group supplemented with S-Cu. The Cu-Gly-treatment enhanced the content of proteoglycans (except the OG50 group). Dietary Cu given to adult rats in the Cu-Gly complex covering the daily demand in 75% exerted a positive effect on bone metabolism and appeared to be the most effective among the investigated doses of the organic form.

Dietary copper and human health: Current evidence and unresolved issues

Although copper (Cu) is recognized as an essential trace element, uncertainties remain regarding Cu reference values for humans, as illustrated by discrepancies between recommendations issued by different national authorities. This review examines human studies published since 1990 on relationships between Cu intake, Cu balance, biomarkers of Cu status, and health. It points out several gaps and unresolved issues which make it difficult to assess Cu requirements. Results from balance studies suggest that daily intakes below 0.8 mg/day lead to net Cu losses, while net gains are consistently observed above 2.4 mg/day. However, because of an incomplete collection of losses in all studies, a precise estimation of Cu requirements cannot be derived from available data. Data regarding the relationship between Cu intake and potential biomarkers are either too preliminary or inconclusive because of low specificity or low sensitivity to change in dietary Cu over a wide range of intakes. Results from observation and intervention studies do not support a link between Cu and a risk of cardiovascular disease, cognitive decline, arthritis or cancer for intakes ranging from 0.6 to 3mg/day, and limited evidence exists for impaired immune function in healthy subjects with a very low (0.38 mg/day) Cu intake. However, data from observation studies should be regarded with caution because of uncertainties regarding Cu concentration in various foods and water. Further studies that accurately evaluate Cu exposure based on reliable biomarkers of Cu status are needed.

Solving the Measurement Problem and then Steppin' Out over the Line Riding the Rarest Italian: Crossing the Streams to Retrieve Stable Bioactivity in Majorana Bound States of Dialy zed Human Platelet Lysates

Exhaustive dialysis (ED) of lysed human platelets against dilute HCl yields stable angiogenic activity. Dialysis against a constrained external volume, with subsequent relaxation of the separation upon opening the dialysis bag, produces material able to maintain phenotypes and viability of human cells in culture better than ED material. Significant graded changes in MTT viability measurement tracked with external volume. The presence of elements smaller than the MW cutoff, capable of setting up cycling currents initiated by oriented flow of HCl across the membrane, suggests that maturation of bioactivity occurred through establishment of a novel type of geometric phase. These information-rich bound states fit recent descriptions of topological order and Majorana fermions, suggesting relevance in testing Penrose and Hameroff's theory of Orchestrated Objective Reduction, under conditions more general, and on finer scales, than those dependent on tubulin protein. The Berry curvature appears to be a good tool for building a general field theory of physiologic stress dependent on the quantum Hall effect. A new form of geometric phase, and an associated "geometric" quantum Hall effect underlying memory retrieval, dependent on the rate of path traversal and reduction from more than two initial field influences is described.

Urinary concentrations of toxic and essential trace elements among rural residents in Hainan Island, China

BACKGROUND

Toxic element exposure and essential trace element consumption may have changed after the Chinese economy transformed to a market-oriented system. The objectives of this study were to measure urinary concentrations of toxic (arsenic, cadmium, lead) and essential trace (selenium, zinc, copper) elements among rural residents in Hainan, China and to examine if variations in economic development are linked to differences in toxic and trace element exposure.

METHODS

We conducted a questionnaire-based survey and undertook anthropometric measurements of residents aged ≥20 years (n = 599). Urinary samples were collected and analyzed using inductively coupled plasma mass spectrometry.

RESULTS

The median (μg/g creatinine) element concentrations were: arsenic, 73.2; cadmium, 1.8; lead, 3.1; selenium, 36.5; zinc, 371; and copper, 11.0. Intra-community variation in element concentrations was explained by age (arsenic, cadmium, zinc and copper), sex (arsenic, cadmium and selenium: higher in females; zinc: higher in males), body mass index (cadmium) and individual involvement in the market economy as indexed by agrochemical use (lead and selenium). The degree of community-level economic development, which was determined by the proportion of people living in better housing among the study communities, was positively associated with cadmium concentration.

CONCLUSIONS

The degree of community-level economic development was positively associated with urinary cadmium concentration while individual involvement in the market economy was positively associated with lead and selenium.

An exposure-response curve for copper excess and deficiency

There is a need to define exposure-response curves for both Cu excess and deficiency to assist in determining the acceptable range of oral intake. A comprehensive database has been developed where different health outcomes from elevated and deficient Cu intakes were assigned ordinal severity scores to create common measures of response. A generalized linear model for ordinal data was used to estimate the probability of response associated with dose, duration and severity. The model can account for differences in animal species, the exposure medium (drinking water and feed), age, sex, and solubility. Using this model, an optimal intake level of 2.6 mg Cu/d was determined. This value is higher than the current U.S. recommended dietary intake (RDI; 0.9 mg/d) that protects against toxicity from Cu deficiency. It is also lower than the current tolerable upper intake level (UL; 10 mg/d) that protects against toxicity from Cu excess. Compared to traditional risk assessment approaches, categorical regression can provide risk managers with more information, including a range of intake levels associated with different levels of severity and probability of response. To weigh the relative harms of deficiency and excess, it is important that the results be interpreted along with the available information on the nature of the responses that were assigned to each severity score.

Differential impact of copper deficiency in rats on blood cuproproteins

Sensitive blood biochemical markers of dietary copper status are not yet known. Rat models were used to investigate the response of severe copper deficiency in dams and pups by comparing abundance of several cuproproteins in erythrocytes, white blood cells, and platelets. The hypothesis tested was that copper deficiency would result in changes in abundance of cuproproteins in blood cells. Copper-deficient (CuD) Holtzman dams and pups had signs consistent with severe copper deficiency compared with copper-adequate controls including lower liver copper and hemoglobin levels and near total loss of plasma ceruloplasmin diamine oxidase activity. Copper-deficient erythrocytes had lower copper, zinc superoxide dismutase (SOD1) but higher copper metallochaperone for SOD1 (CCS) compared with copper-adequate, resulting in higher CCS/SOD1 levels. This ratio was more sensitive in CuD erythrocytes than CuD white cells and especially in CuD platelets. However, both white blood cells and platelets from CuD dams and pups had nearly nondetectable levels of cytochrome c oxidase subunit IV. Because isolation of relatively pure populations of erythrocytes and platelets is feasible, and reagents for immunoblot methods are available, determination of CCS/SOD1 and cytochrome c oxidase subunit IV protein levels may be useful to assess copper status of humans.

Methods of assessment of copper status in humans: a systematic review

BACKGROUND

The assessment of dietary adequacy of copper is constrained by the absence of recognized copper status biomarkers.

OBJECTIVES

The objectives were to systematically review the usefulness of copper status biomarkers and identify those that reflected changes in status over > or =4 wk.

DESIGN

The methods included a structured search on Ovid MEDLINE, EMBASE (Ovid), and Cochrane databases to October 2007, followed by the use of formal inclusion/exclusion criteria, data extraction, validity assessment, and meta-analysis.

RESULTS

A total of 16 studies (288 participants) were included in the review, with data on 16 possible copper biomarkers. All of the included studies were small and at high risk of bias. Data for serum copper suggested its value as a biomarker, reflecting changes in status in both depleted and replete individuals, although these changes were smaller in the latter. Total ceruloplasmin protein is related to copper status but reflects changes in highly depleted individuals only. Erythrocyte superoxide dismutase and urinary deoxypyridinoline are not useful biomarkers, but there were insufficient data to draw firm conclusions about plasma, erythrocyte, and platelet copper; leukocyte superoxide dismutase; erythrocyte, platelet, and plasma glutathione peroxidase; platelet and leukocyte cytochrome-c oxidase; total glutathione; diamine oxidase; and urinary pyridinoline. The paucity of data prevented detailed subgroup analysis.

CONCLUSIONS

Despite limited data, serum copper appears to be a useful biomarker of copper status at the population level. Further large studies with low risk of bias are needed to explore the effectiveness of other biomarkers of copper status and the relation between biomarker responsiveness, dose, and period of supplementation.

Biomarkers of copper status: a brief update

The essentiality of copper (Cu) in humans is demonstrated by various clinical features associated with deficiency, such as anaemia, hypercholesterolaemia and bone malformations. Despite significant effort over several decades a sensitive and specific Cu status biomarker has yet to be identified. The present article updates a comprehensive review recently published by the authors which assesses the reliability and robustness of current biomarkers and outlines the on-going search for novel indicators of status(1). The essential features of this earlier review are reiterated whilst considering whether there are other approaches, not yet tested, which may provide valuable information in the quest for an appropriate measure of copper status. Current biomarkers include a range of cuproenzymes such as the acute phase protein caeruloplasmin and Cu-Zn-superoxide dismutase all of which are influenced by a range of other dietary and environmental factors. A recent development is the identification of the Cu chaperone, CCS as a potential biomarker; although its reliability has yet to be established. This appears to be the most promising potential biomarker, responding to both Cu deficiency and excess. The potential for identifying a 'suite' of biomarkers using high-throughput technologies such as transcriptomics and proteomics is only now being examined. A combination of these technologies in conjunction with a range of innovative metal detection techniques is essential if the search for robust copper biomarkers is to be successful.

Present situation of biomarkers for copper status

Serum or plasma copper and ceruloplasmin concentrations are the most widely used laboratory indicators to evaluate copper status. Both indicators are decreased in moderate or severe copper deficiency. The activity of several cuproenzymes is decreased in mild copper deficiency. However, their use is limited by the nonexistence of standardized assays and high interindividual variability and because some of these indicators are affected by other conditions. Recently, it was shown that the protein expression of the copper chaperone for superoxide dismutase (CCS) is increased in erythrocytes of rodents with mild copper deficiency. However, no traditional laboratory indicators have been identified as potential early markers of copper excess. It is possible that the biomarkers studied so far are not sensitive enough to detect an increase in body copper before the appearance of functional or clinical effects or that the homeostatic mechanisms are so strong that no significant changes in body copper occur with mild-to-moderate copper exposure. The identification of appropriate biomarkers for early detection of an increase in body copper represents a major challenge for further research, and the development of new approaches, such as network biology, allows us to search and propose new candidates to be studied. Recently, we found that CCS mRNA abundance in mononuclear blood cells significantly decreased after copper supplementation. The usefulness of this indicator to detect an increase in body copper should be assessed in clinical trials.

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.

How reliable and robust are current biomarkers for copper status?

Cu is an essential nutrient for man, but can be toxic if intakes are too high. In sensitive populations, marginal over- or under-exposure can have detrimental effects. Malnourished children, the elderly, and pregnant or lactating females may be susceptible for Cu deficiency. Cu status and exposure in the population can currently not be easily measured, as neither plasma Cu nor plasma cuproenzymes reflect Cu status precisely. Some blood markers (such as ceruloplasmin) indicate severe Cu depletion, but do not inversely respond to Cu excess, and are not suitable to indicate marginal states. A biomarker of Cu is needed that is sensitive to small changes in Cu status, and that responds to Cu excess as well as deficiency. Such a marker will aid in monitoring Cu status in large populations, and will help to avoid chronic health effects (for example, liver damage in chronic toxicity, osteoporosis, loss of collagen stability, or increased susceptibility to infections in deficiency). The advent of high-throughput technologies has enabled us to screen for potential biomarkers in the whole proteome of a cell, not excluding markers that have no direct link to Cu. Further, this screening allows us to search for a whole group of proteins that, in combination, reflect Cu status. The present review emphasises the need to find sensitive biomarkers for Cu, examines potential markers of Cu status already available, and discusses methods to identify a novel suite of biomarkers.

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.

Response of putative indices of copper status to copper supplementation in human subjects

No sensitive functional index is currently available to assess Cu status in healthy human populations. This study evaluated the effect of Cu supplementation on putative indices of Cu status in twelve women and twelve men, aged between 22 and 45 years, who participated in a double-blind placebo controlled crossover study. The study consisted of three 6-week supplementation regimens of 3 mg CuSO4, 3 mg Cu-glycine chelate and 6 mg Cu-glycine chelate, each separated by placebo periods of equal length. Women had significantly higher caeruloplasmin oxidase activity (P < 0·001), caeruloplasmin protein concentration (P < 0·05), and serum diamine oxidase activity (P < 0·01) at baseline than men. Erythrocyte and leucocyte superoxide dismutase activity, leucocyte cytochrome c oxidase activity, and erythrocyte glutathione peroxidase activity did not respond to Cu supplementation. Platelet cytochrome c oxidase activity was significantly higher (P < 0·01), after supplementation with 6 mg Cu-glycine chelate in the total group and in women but did not change in men. Caeruloplasmin oxidase activity was significantly higher (P < 0·05), in men after supplementation with 3 mg Cu-glycine chelate, while caeruloplasmin protein concentration was significantly lower in men after supplementation with 6 mg Cu-glycine chelate (P < 0·05). Serum diamine oxidase activity was significantly higher after all supplementation regimens in the total group and in both men and women (P < 0·01). These results indicate that serum diamine oxidase activity is sensitive to changes in dietary Cu intakes and may also have the potential to evaluate changes in Cu status in healthy adult human subjects.

Effect of copper supplementation on indices of copper status and certain CVD risk markers in young healthy women

Western diets containing suboptimal Cu concentrations could be widespread. A link between marginal Cu deficiency and CVD has been suggested. The objective of the present study was to investigate the effect of Cu supplementation on both Cu status and CVD risk factors in healthy young women. Sixteen women with a mean age of 24 (sd 2) years participated in a randomised crossover study of three 4-week periods with 3-week washouts between periods. During each intervention period, subjects received 0, 3 or 6 mg elemental Cu/d as CuSO4in addition to their habitual diet. Blood samples were taken to assess the effect of supplementation on putative markers of Cu status. The content of plasma lipids, lipoprotein (a), apo and certain haemostatic factors, as putative indices of CVD, was also analysed. Daily supplementation with 3 mg Cu significantly increased (P<0·05) serum Cu concentration and the activity of erythrocyte superoxide dismutase, although there was no further significant increase after an intake of 6 mg Cu/d. The concentration of the fibrinolytic factor plasminogen activator inhibitor type 1 was significantly reduced (P<0·05) by about 30% after supplementation with 6 mg Cu/d. No other marker of Cu status or CVD risk factor was affected by Cu supplementation. The results indicate that supplementation with 3 or 6 mg Cu/d may improve Cu status in these healthy young women. Increased Cu intake could reduce the risk of CVD and atherosclerosis in man by promoting improved fibrinolytic capacity.

Zinc and copper metabolism in pregnancy and lactation of adolescent women

OBJECTIVE

Pregnant and lactating adolescent women are at risk of zinc and copper deficiency but their capacity for metabolic adaptation is poorly known. This study investigated the effect of pregnancy and lactation on zinc and copper metabolism in adolescent women by comparing biochemical indices between groups in different reproductive states.

METHODS

Habitual dietary intake and biochemical indices (zinc, copper, alkaline phosphatase, and ceruloplasmin in plasma; zinc [E-Zn], metallothionein [E-MT], and superoxide dismutase [E-SOD] in erythrocytes) and their relation were compared among non-pregnant non-lactating adolescents (NPNLs; n = 26), third-trimester pregnant adolescents (PAs; n = 26), and lactating adolescents up to 3 mo postpartum (LAs; n = 21).

RESULTS

Zinc and copper intakes were not different across groups (on average, 8.7 and 1.0 mg/d, respectively). PAs had lower plasma zinc but higher plasma copper, alkaline phosphatase, and ceruloplasmin levels than did LAs and NPNLs (P < 0.05). E-SOD and E-Zn were similar in all groups but E-MT was higher in the PA and LA groups than in the NPNL group (P < 0.05). Correlations between plasma copper and ceruloplasmin and between E-MT and E-Zn were observed in the LA and NPNL groups (r > or = 0.64, P < 0.01) but not in the PA group. In contrast, correlations between plasma alkaline phosphatase and plasma zinc, between E-MT and plasma zinc, and between E-SOD and E-Zn were observed only in the PA group (r > or = 0.46, P < 0.05).

CONCLUSION

Zinc and copper biochemical responses to pregnancy and lactation in the adolescent women studied appeared qualitatively similar to those described in previous studies in adult women. However, the significant correlations observed between the activity of zinc-dependent enzymes and plasma (or erythrocyte) zinc suggest that a poor maternal zinc status may limit the metabolic adaptation capacity of these adolescent women especially during pregnancy.

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.

Changes in tubular dysfunction marker levels in parallel with the levels of copper, rather than cadmium, in urine of middle-aged women in non-polluted areas

OBJECTIVE

This study was initiated to investigate if and to what extent the elevations in urinary alpha(1)- and beta(2)-microglobulins (alpha(1)-MG and beta(2)-MG, respectively) are specific to Cd nephro-toxicity.

METHODS

Stored urine samples, collected from 1,000 adult women in 11 prefectures all over Japan, were analysed for eight elements (Ca, Cd, Co, Cu, Mg, Mn, Ni and Zn), alpha(1)-MG, beta(2)-MG, creatinine (CR) and specific gravity (SG); the data were cited from previous publications. The levels of eight elements and two MGs were expressed as observed and after correction for CR or SG (1.016). Age, CR and SG distributed normally, whereas two MGs and eight elements distributed log-normally. The 1,000 cases were classified into quartiles (i.e., 250 cases/group) of the lowest to the highest values (Groups A to D) for each element.

RESULTS

alpha(1)-MG and beta(2)-MG increased as a function of Ca, Cd and Cu when corrected for CR, and the two MGs increased in parallel only with Cd and Cu after SG correction. Prevalence of alpha(1)-MG-uria (cut-off values; 5.3 and 6.5 mg/g cr or l) and beta(2)-MG-uria (cut-off values; 300 and 400 microg/g cr or l) was elevated with increasing Ca, Cd and Cu when corrected for CR, but only with Cd and Cu when corrected for SG. Multiple regression analysis of 353 cases of 50-59 year-old women with the eight element levels as independent variables and one of the two MGs as a dependent variable showed that Cu was the most influential element, and both Cd and Zn were less influential.

CONCLUSIONS

Urinary levels of alpha(1)-MG and beta(2)-MG among women with no environmental Cd exposure correlated more closely with Cu levels than Cd levels in urine. The observation suggests that sub-clinical elevation in alpha(1)-MG and beta(2)-MG is not always attributable to nephro-toxicity of Cd, and that consideration on possible effects of other elements such as Cu is necessary.

Reference values for cobalt, copper, manganese, and nickel in urine among women of the general population in Japan

OBJECTIVE

The present study was initiated to establish the reference levels of Co, Cu, Mn, and Ni in urine of women in the general Japanese population.

METHODS

Stored urine samples were subjected to the analysis. The samples were collected from 1,000 adult women all over Japan, who had no occupational exposure to these elements. Co, Cu, Mn, and Ni in urine were analyzed by graphite furnace atomic absorption spectrometry. The concentrations were distributed log-normally, and were presented in terms of geometric mean (GM) and geometric standard deviation, as observed or after correction for creatinine concentration or a specific gravity of urine of 1.016.

RESULTS

The GM values of observed levels (i.e., with no correction for urine density) and of the levels after correction for creatinine (cr) concentration (values in parenthesis) were 0.68 g/l (0.60 microg/g cr) for Co, 13.4 g/l (11.8 g/g cr) for Cu, 0.14 microg/l (0.12 g/g cr) for Mn and 2.1 g/l (1.8 g/g cr) for Ni. There was a life-long age-dependent increase in Cu. Mn levels reached the maximum at 60 to 69 years of ages. In contrast, age-dependency was not substantial in Co and Ni.

CONCLUSIONS

Comparison with values reported in literatures for other areas showed that Co and Ni levels in urine of Japanese women are higher than, Cu level is comparable with, and Mn level is lower than others. The reasons for high Co and Ni levels deserve further study.

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.

Demonstration of a hyperglycemia-driven pathogenic abnormality of copper homeostasis in diabetes and its reversibility by selective chelation: quantitative comparisons between the biology of copper and eight other nutritionally essential elements in normal and diabetic individuals

We recently showed that treatment with the Cu(II)-selective chelator, trientine, alleviates heart failure in diabetic rats, improves left ventricular hypertrophy in humans with type 2 diabetes, and increases urinary Cu excretion in both diabetic rats and humans compared with nondiabetic control subjects. In this study, we characterized the homeostasis of Cu and eight other nutritionally essential elements in diabetes under fully residential conditions in male subjects with type 2 diabetes and age-matched control subjects. We then probed elemental balance with oral trientine in a parallel-group, placebo-controlled study in these subjects. Before treatment, there were no detectable between-group differences in the balance of any element, although urinary output of several elements was greater in diabetic subjects. Mean extracellular superoxide dismutase (EC-SOD) activity was elevated in diabetic subjects, and its activity correlated strongly with the interaction between [Cu]serum and HbA1c. Trientine caused the Cu balance to become negative in diabetic subjects through elevated urinary Cu losses and suppressed elevated EC-SOD. Basal urinary Cu predicted urinary Cu losses during treatment, which caused extraction of systemic Cu(II). We suggest that cardiovascular complications in diabetes might be better controlled by therapeutic strategies that focus on lowering plasma glucose and loosely bound systemic Cu(II).

Long-term high copper intake: effects on copper absorption, retention, and homeostasis in men

BACKGROUND

Numerous studies have examined the effect of low and adequate intakes of copper on absorption and retention, but little information is available on the regulation of absorption and retention of copper when intake is high.

OBJECTIVE

A study was conducted in men to determine the effect of long-term high copper intake on copper absorption, retention, and homeostasis.

DESIGN

Nine men were confined to a metabolic research unit (MRU) for 18 d and were fed a 3-d rotating menu containing an average of 1.6 mg Cu/d. They continued the study under free-living conditions for 129 d, supplementing their usual diets with 7 mg Cu/d. They then returned to the MRU for 18 d and consumed the same diet as during the first period, except that copper intake was 7.8 mg/d. The stable isotope (63)Cu was fed to 3 subjects and infused into the other 6 on day 7 of each MRU period, and complete urine and stool collections were made throughout the study. Total copper and (63)Cu were determined by inductively coupled plasma mass spectrometry. Copper absorption, excretion, and retention were calculated on the basis of dietary, urinary, and fecal copper and (63)Cu.

RESULTS

Results were as follows when comparing the high copper intake with the usual intake: fractional copper absorption was significantly lower, but the amount absorbed was significantly higher; excretion of the infused (63)Cu was significantly faster; and total retention was significantly higher.

CONCLUSIONS

Homeostatic regulation of copper absorption and retention helped to minimize the amount of copper retained with high copper intake but was not sufficient to prevent retention of >0.6 mg Cu/d.

Toxicity of copper intake: lipid profile, oxidative stress and susceptibility to renal dysfunction

The present study was carried out to investigate the effects of copper (Cu) intake on lipid profile, oxidative stress and tissue damage in normal and in diabetic condition. Since diabetes mellitus is a situation of high-risk susceptibility to toxic compounds, we examined potential early markers of Cu excess in diabetic animals. Male Wistar rats, at 60-days-old were divided into six groups of eight rats each. The control(C) received saline from gastric tube, the no-diabetic(Cu-10), treated with 10 mg/kg of Cu(Cu(++)-CuSO4, gastric tube), no-diabetic with Cu-60 mg/kg(Cu-60), diabetic(D), diabetic low-Cu(DCu-10) and diabetic high-Cu(DCu-60). Diabetes was induced by an ip injection of streptozotocin (60 mg/kg). After 30 days of treatments, no changes were observed in serum lactate dehydrogenase, alanine transaminase and alkaline phosphatase, indicating no adverse effects on cardiac and hepatic tissues. D-rats had glucose intolerance and dyslipidemic profile. Cholesterol and LDL-cholesterol were higher in Cu-60 and DCu-60 than in C, Cu-10 and D and DCu-10 groups respectively. Cu-60 rats had higher lipid hydroperoxide (HP) and lower superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) serum activities than C and Cu-10 rats. LH was increased and GSH-Px was decreased, while no alterations were observed in SOD and catalase in serum of DCu-60 animals. DCu-60 rats had increased urinary glucose, creatinine and albumin. In conclusion, Cu intake at high concentration induced adverse effects on lipid profile, associated with oxidative stress and diminished activities of antioxidant enzymes. Diabetic animals were more susceptible to copper toxicity. High Cu intake induced dyslipidemic profile, oxidative stress and kidney dysfunction in diabetic condition. Copper renal toxicity was associated with oxidative stress and reduction at least, one of the antioxidant enzymes.

Maintaining copper homeostasis: regulation of copper-trafficking proteins in response to copper deficiency or overload

Copper is an essential micronutrient that plays a vital role as a catalytic co-factor for a variety of metalloenzymes. The redox chemistry of copper also makes it a potentially toxic metal if not properly used. Therefore, elaborate mechanisms have evolved for controlling its cellular uptake, elimination, and distribution. In the last decade, our understanding of the systems involved in maintaining copper homeostasis has improved considerably with the characterization of copper transporters that mediate cellular copper uptake or efflux and with the identification of copper chaperones, a family of proteins required for delivering copper to specific targets in the cell. Despite the distinct roles of these proteins in copper trafficking, all seem able to respond to changes in copper status. Here, we describe recent advances in our knowledge of how copper-trafficking proteins respond to copper deficiency or overload in mammalian cells in order to maintain copper balance.

Copper enzyme activities in cystic fibrosis before and after copper supplementation plus or minus zinc

One laboratory reports low activities for 2 blood copper enzymes in subjects with cystic fibrosis (CF), which suggests that moderate copper deficiency is common in this state. The present study attempted to confirm this proposition in 3 ways: repeat the measures for 1 of the 2 copper enzymes (superoxide dismutase) in a new group of CF patients (males and females, N = 38), add another copper enzyme measure (plasma diamine oxidase) that has high sensitivity to copper status, and test if copper enzyme activities in CF patients rise by copper supplementation. The last test was performed plus or minus zinc supplementation since poor zinc status may contribute to poor copper status. The results for the first 2 aims supported the idea of poor copper status, as low activities were found for CF subjects for 2 copper enzyme activities, erythrocyte superoxide dismutase and plasma diamine oxidase (although normal activities were obtained for another copper enzyme, plasma ceruloplasmin, both as U/mL plasma or U/mg ceruloplasmin immunoreactive protein). For the last aim, copper enzyme activities were not altered by copper supplementation (6 weeks, 3 mg copper/d as copper-glycinate), plus or minus concurrent zinc supplementation (30 mg zinc/d as zinc-glycinate). Therefore, CF may cause a tendency to moderate copper deficiency, which may be due to abnormal copper metabolism not easily corrected by increased copper and/or zinc intake.

Peanut consumption improves indices of cardiovascular disease risk in healthy adults

BACKGROUND

Diets containing nuts reduce cardiovascular disease (CVD) risk factors. This has primarily been attributed to their fatty acid composition, but other constituents may also contribute. Peanuts, the most widely consumed "nut" (actually a legume), are a rich source of monounsaturated fatty acids (MUFA), magnesium and folate, but their effects on CVD risk factors are poorly characterized.

OBJECTIVE

This study determined the effects of chronic peanut consumption on diet composition as well as serum lipids, magnesium and homocysteine concentrations in free-living subjects under different conditions of peanut intake.

DESIGN

Fifteen normolipidemic adults participated in a 30-week cross-over intervention. Subjects were provided 500 (+136) kcal as peanuts during an eight-week free feeding (FF) diet. The same amount of peanuts was added during a three-week addition (ADD) diet or replaced an equal amount of other fats in the diet during an eight-week substitution (SUB) diet.

RESULTS

Energy intake from fat was increased through greater intake of MUFA and polyunsaturated fatty acids, while saturated fatty acid intake remained relatively stable under all conditions. Triacylglycerol (TAG) was reduced by 24% during ADD (p < 0.05), by 17% during SUB (p < 0.05) and by 14% during four-weeks of FF, but then rebounded to baseline by week 8. Dietary fiber, magnesium, folate, alpha tocopherol, copper and arginine increased during all treatments (p < 0.05). Serum magnesium increased in 13 of 15 subjects during FF (p < 0.05). No changes were found in total plasma homocysteine concentration.

CONCLUSIONS

Regular peanut consumption lowers serum TAG, augments consumption of nutrients associated with reduced CVD risk and increases serum magnesium concentration.

Biomarkers of trace mineral intake and status

The emerging public health importance of zinc and selenium and the continuing public health challenges of iron and iodine draw attention to the unmet need for improved biomarkers of trace element status. Currently available biomarkers of these four trace elements are critiqued including the outstanding lack of satisfactory biomarkers for the assessment of zinc intake and status. Other trace elements are reviewed briefly including copper, for which human dietary deficiencies and excesses have been documented, and chromium, which is of possible but unconfirmed public health significance. Evolving strategies of considerable potential include molecular techniques such as the measurement of metallothionein mRNA in lymphocytes as a biomarker of zinc status, an assay that can now be performed with a dried blood spot. The judicious application of tracer techniques also has a role in advancing the quality of zinc biomarkers. Also of special current interest is full definition of the potential of plasma-soluble transferrin receptor concentrations as the biomarker of choice for the detection of early functional iron deficiency.

Copper deficiency induces the upregulation of the copper chaperone for Cu/Zn superoxide dismutase in weanling male rats

The most commonly used indices for determining copper deficiency in humans are reduced serum/plasma copper concentration and decreased activity of ceruloplasmin and Cu/Zn superoxide dismutase (SOD1). However, these indicators are influenced by many factors unrelated to copper status and lack the sensitivity required to detect marginal deficiency, limiting their usefulness in many situations. In vivo, the insertion of copper into SOD1 is dependent on the copper chaperone for SOD1 (CCS). In this study, we explored the possibility that the expression level of CCS may reflect copper status and thus serve as a useful marker of copper nutriture. Weanling male Wistar rats were fed either a normal (5.3 mg Cu/kg diet), moderately deficient (0.84 mg Cu/kg diet) or deficient (0.34 mg Cu/kg diet) copper diet for 6 wk. Rats fed moderate and deficient diets showed differences (P < 0.05) in several hematological measurements, indicating varying degrees of copper deficiency in these groups. Copper-deficient rats had reduced (P < 0.05) liver and erythrocyte SOD1 activity and body weight. Western blot analysis revealed a dose-dependent increase (P < 0.05) in CCS expression in liver and erythrocytes of copper-deficient rats. We report CCS protein level as a novel marker for assessing copper status.

Hohenheim consensus workshop: copper

Copper (Cu) is an essential trace element with many physiological functions. Homeostatic mechanisms exist to allow Cu to act as a cofactor in enzymatic processes and to prevent accumulation of Cu to toxic levels. The aim of this commentary is to better understand the role of dietary Cu supply in deficiency and under physiological and pathological conditions. The essentiality of Cu can be attributed to its role as a cofactor in a number of enzymes that are involved in the defence against oxidative stress. Cu, however, has a second face, that of a toxic compound as it is observed with accumulating evidence in hepatic, neurodegenerative and cardiovascular diseases. The destructive potential of Cu can be attributed to inherent physico-chemical properties. The main property is its ability to take part in Fenton-like reactions in which the highly reactive and extremely deleterious hydroxyl radical is formed. Diseases caused by dietary Cu overload could be based on a genetic predisposition. Thus, an assessment of risk-groups, such as infants with impaired mechanisms of Cu homeostasis regarding detoxification, is of special interest, as their Cu intake with resuspended formula milk may be very high. This implies the need for reliable diagnostic markers to determine the Cu status. These topics were introduced at the workshop by the participants followed by extensive group discussion. The consensus statements were agreed on by all members. One of the conclusions is that a re-assessment of published data is necessary and future research is required.

Low dietary zinc alters indices of copper function and status in postmenopausal women

OBJECTIVES

To better define the relationship between dietary zinc and copper for humans so that sound recommendations for intakes of these elements can be made.

METHODS

A study was conducted to ascertain the effect of moderately excessive and deficient intakes of zinc on copper metabolism and use in humans fed low and luxuriant amounts of copper. Twenty-one postmenopausal women housed in a metabolic unit completed the study as designed. After a 10-d equilibration period in which they were fed a diet providing 31.5 micromol (2 mg) Cu and 91.8 micromol (9 mg) Zn/8.4 MJ (2000 kcal), the women were divided into two groups. One group was fed a diet containing 15.7 micromol (1 mg) Cu/8.4 MJ (2000 kcal), and the other group was fed a diet containing 47.2 micromol (3 mg) Cu/8.4 MJ (2000 kcal). After equilibration, both groups were fed the basal diet providing 45.9 micromol (3 mg) Zn/8.4 MJ (2000 kcal) for 90 d; this was followed by another 10-d equilibration period before dietary zinc was increased to 811 micromol (53 mg)/8.4 MJ (2000 kcal) for 90 d.

RESULTS

The women were in positive copper balance only when the diet provided 47.2 micromol (3 mg) Cu and 811 micromol (53 mg) Zn/d. Immunoreactive ceruloplasmin concentrations and platelet cytochrome-c oxidase activity on a platelet number basis were significantly lower and the ratio between enzymatic and immunoreactive ceruloplasmin was significantly higher during low dietary than during high dietary zinc intake. Serum cholesterol was higher in subjects fed 15.7 micromol (1 mg) Cu/d than in those fed 47.2 micromol (3 mg) Cu/d. Total and low-density lipoprotein cholesterol concentrations decreased with zinc supplementation. Whole-blood glutathione concentration and erythrocyte glutathione peroxidase activity were lower during high than during low dietary zinc intake.

CONCLUSIONS

The findings indicate that an inadequate intake of zinc (45.9 micromol/d; 3 mg/d) was more effective than a moderately high intake of zinc (811 micromol/d; 53 mg/d) in inducing changes associated with a decreased copper status in postmenopausal women. Furthermore, the findings indicate that copper status indicators might be useful in evaluating changes in zinc status in humans, and an intake of 15.7 micromol (1 mg)/d of copper may be inadequate for postmenopausal women.

No effect of copper supplementation on biochemical markers of bone metabolism in healthy young adult females despite apparently improved copper status

OBJECTIVE

To investigate the effects of increasing Cu intakes, above the usual dietary intake, on biomarkers of bone metabolism in healthy young adult females (aged 21-28 y) over a 4 week period.

DESIGN

A double-blind, placebo-controlled randomised repeat crossover Cu supplementation trial.

SETTING

The study was conducted at the Royal Veterinary and Agricultural University (RVAU), Copenhagen, Denmark.

SUBJECTS

Sixteen healthy young adult females aged 20-28 y were recruited from among students at the RVAU.

INTERVENTION

During the 4 week intervention periods in this randomised, crossover trial (3x4 weeks with a minimum 3 week wash-out period), each subject received, in addition to their usual diet, either 3 or 6 mg elemental Cu/day as CuSO4 or a matching placebo. On the last 3 days of each dietary period 24 h urines were collected. In addition, blood was collected on the last day of each dietary period.

RESULTS

Serum Cu and erythrocyte superoxide dismutase (but not caeruloplasmin protein concentration or activity (putative indices of Cu status)) were significantly increased (P<0.05) after daily Cu supplementation with 3 and 6 mg/day for 4 weeks. Serum osteocalcin (biomarker of bone formation), urinary creatinine (Cr) concentration, urinary pyridinoline (Pyr)/Cr or deoxypyridinoline (Dpyr)/Cr excretion, or daily urinary Pyr or Dpyr excretion (biomarkers of bone resorption) were unaffected by Cu supplementation.

CONCLUSION

Copper supplementation of the usual diet in healthy young adult females, while apparently improving Cu status, had no effect on biochemical markers of bone formation or bone resorption over 4 week periods.

SPONSORSHIP

Funding from the European Commission.

Copper supplementation in humans does not affect the susceptibility of low density lipoprotein to in vitro induced oxidation (FOODCUE project)

The oxidative modification of low-density lipoprotein cholesterol (LDL) has been implicated in the pathogenesis of atherosclerosis. Copper (Cu) is essential for antioxidant enzymes in vivo and animal studies show that Cu deficiency is accompanied by increased atherogenesis and LDL susceptibility to oxidation. Nevertheless, Cu has been proposed as a pro-oxidant in vivo and is routinely used to induce lipid peroxidation in vitro. Given the dual role of Cu as an in vivo antioxidant and an in vitro pro-oxidant, a multicenter European study (FOODCUE) was instigated to provide data on the biological effects of increased dietary Cu. Four centers, Northern Ireland (coordinator), England, Denmark, and France, using different experimental protocols, examined the effect of Cu supplementation (3 or 6 mg/d) on top of normal Cu dietary intakes or Cu-controlled diets (0.7/1.6/6.0 mg/d), on Cu-mediated and peroxynitrite-initiated LDL oxidation in apparently healthy volunteers. Each center coordinated its own supplementation regimen and all samples were subsequently transported to Northern Ireland where lipid peroxidation analysis was completed. The results from all centers showed that dietary Cu supplementation had no effect on Cu- or peroxynitrite-induced LDL susceptibility to oxidation. These data show that high intakes (up to 6 mg Cu) for extended periods do not promote LDL susceptibility to in vitro-induced oxidation.

The effect of copper supplementation on red blood cell oxidizability and plasma antioxidants in middle-aged healthy volunteers

A multicenter European study (FoodCue) was undertaken to provide data on the significance of increased dietary copper as a pro-oxidant or antioxidant in vivo. The present work describes the effect of Cu supplementation on (2,2'-azo-bis(2-amidinopropane) hydrochloride (AAPH)-induced red blood cell oxidation in middle-aged people. Double-blinded copper supplementation was achieved in 26 healthy volunteers (50-70 years) with pills containing 3 mg CuSO(4), 3 mg Cu glycine chelate (CuG) and 6 mg CuG. Each 6 week supplementation period was preceded and followed by 6 weeks of washout (WO) on placebo. The results show significant increases in time necessary to achieve 50% hemolysis (LT(50)) after 3CuSO(4) and 6CuG compared with values after WO periods. Cu supplementation did not increase the levels of (Cu,Zn)SOD activity in red blood cells. Resistance to hemolysis was significantly and positively correlated (r =.30, p <.01) with alpha- and beta-carotene content in the plasma. Together, these data suggest that intake of copper as high as 7 mg/d has no pro-oxidant activity and may rather result in protection of red blood cells against oxidation. The decreased oxidizability of red blood cells did not result from increased (Cu,Zn)SOD activity and may occur through other mechanisms such as changes in membrane antioxidant content.

Are copper, zinc and selenium in erythrocytes valuable biological indexes of nutrition and pathology?

The real significance of the level of trace elements copper, zinc and selenium in erythrocytes is still a matter of debate. This review is an evaluation of the potential value of copper, zinc and selenium in red blood cells in physiology, nutrition and pathology, taking into account the other commonly used indices and the analytical difficulty encountered for erythrocyte determinations. The main analytical methods and reference values in erythrocytes are also presented. The literature of the last 3 decades was analyzed. On the basis of these papers, the role of erythrocyte copper in various pathologies should be re-investigated, especially when they include inflammatory processes or hormonal changes. The main interest of zinc determination in red blood cells concerns thyroid pathology. In general, the value of selenium in erythrocytes agrees with selenium in serum and its determination is often unnecessary.