1
|
Moriya K, Saeki K, Nishimura N, Sato S, Sawada Y, Takaya H, Kaji K, Kawaratani H, Namisaki T, Akahane T, Yoshiji H. Zinc Supplementation and an Improved Quality of Life in Patients with Autoimmune Hepatitis. Intern Med 2024; 63:145-152. [PMID: 37197963 PMCID: PMC10864085 DOI: 10.2169/internalmedicine.1817-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/30/2023] [Indexed: 05/19/2023] Open
Abstract
Objecive Patients with autoimmune hepatitis (AIH) reportedly have an impaired quality of life (QOL), mainly due to depression, even during remission. In addition, hypozincaemia has been demonstrated in patients with chronic liver disease, including AIH, and is known to be related to depression. Corticosteroids are known to cause mental instability. We therefore investigated the longitudinal association between zinc supplementation and changes in the mental status among AIH patients treated with corticosteroids. Materials This study enrolled 26 patients with serological remission of AIH routinely treated at our facility after excluding 15 patients who either discontinued polaprezinc (150 mg/day) within 24 months or interrupted treatment. Two questionnaires, the Chronic Liver Disease Questionnaire (CLDQ) and SF-36, were adopted to evaluate the QOL before and after zinc supplementation. Results Serum zinc levels were significantly elevated after zinc supplementation (p<0.0001). The CLDQ worry subscale significantly improved after zinc supplementation (p=0.017), but none of the SF-36 subscales was affected. Multivariate analyses demonstrated that daily prednisolone dosing was inversely related to both the CLDQ worry domain score (p=0.036) and the SF-36 mental health component (p=0.031). There was a significant negative correlation between the changes in the daily steroid dose and the CLDQ worry domain scores before and after zinc supplementation (p=0.006). No serious adverse events occurred during the observation period. Conclusion Zinc supplementation safely and efficiently improved mental impairment, possibly caused by continuous treatment with corticosteroids, in patients with AIH.
Collapse
Affiliation(s)
- Kei Moriya
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Shinya Sato
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Kosuke Kaji
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Takemi Akahane
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology and Hepatology, Nara Medical University, Japan
| |
Collapse
|
2
|
The Significance of Zinc in Patients with Chronic Liver Disease. Nutrients 2022; 14:nu14224855. [PMID: 36432541 PMCID: PMC9692841 DOI: 10.3390/nu14224855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Zinc is an essential trace element for the maintenance of life because it acts as a center of activity or cofactor for hundreds of enzymes. Zinc deficiency causes a variety of symptoms, including anemia, dermatitis, stomatitis, alopecia, bedsores, decreased appetite, impaired growth, gonadal dysfunction, susceptibility to infection, and taste disorders, etc. In March 2017, zinc acetate hydrate, which had been approved for Wilson disease in Japan, received an additional indication for hypozincemia. Hypozincemia is frequently observed in patients with chronic liver disease (CLD), especially cirrhosis, and it has recently been shown that hypozincemia is closely related to the development of liver fibrosis and increased risk of liver carcinogenesis, in addition to the appearance of various subjective symptoms. Moreover, hypozincemia in CLD may be associated with sarcopenia (i.e., decrease in muscle strength and muscle mass) and frailty (i.e., vulnerability), which receive much attention these days. It is assumed that treatment with zinc acetate hydrate will become widespread in patients with CLD. Zinc acetate hydrate may also have potential for improving sarcopenia in patients with CLD. This review primarily outlines the significance of zinc in patients with CLD.
Collapse
|
3
|
Zinc nutritional status, mood states and quality of life in diarrhea-predominant irritable bowel syndrome: a case-control study. Sci Rep 2022; 12:11002. [PMID: 35768522 PMCID: PMC9243013 DOI: 10.1038/s41598-022-15080-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/17/2022] [Indexed: 12/19/2022] Open
Abstract
Zinc is an important trace element for structure, and regulation in the central nervous system, as well as the gut homeostasis. There are several mental disorders associated with zinc deficiency. The relationship between zinc nutritional status with mood states and quality of life (QoL) in diarrhea-predominant irritable bowel syndrome (IBS-D) has not been studied yet. This case–control study aimed to investigate the association between zinc nutritional status with mood states and QoL in IBS-D patients. Sixty-one newly diagnosed patients with IBS-D and 61 matched healthy controls were enrolled. Dietary zinc intakes and serum zinc levels were measured. Mood states and QoL were evaluated by validated questionnaires. Logistic regression was used to estimate the odds of IBS-D in relation to zinc deficiency. Decreased serum zinc levels were observed in the IBS-D group than in the controls (p = 0.001). There were higher scores of depression (p = 0.014), anxiety (p = 0.005), and stress (p = 0.001) among IBS-D patients. Moreover, overall QoL, physical and psychological health were lower in IBS-D patients compared to the controls (p < 0.001). “Food avoidance” had the lowest, while the “relationship” had the highest score among the patients (51.09 ± 26.80 and 78.14 ± 23.30, respectively). Dietary zinc intake was positively correlated with psychological health in the controls (r = 0.295, p = 0.022) and with body image in the patients (r = 0.266, p = 0.044). According to the logistic regression, zinc deficiency was not significantly associated with odds of IBS-D. Findings show that zinc deficiency may be associated with some parameters of IBS-D. Further clinical studies are needed to explore the causal relationship between zinc status and IBS pathogenesis.
Collapse
|
4
|
Morisaku M, Ito K, Ogiso A, Imai M, Hiraoka Y, Zennami M, Tsuge M, Mori M, Toyosato S, Matsuda H, Ando Y, Tokuda M, Tomita A, Yamada S. Correlation between serum albumin and serum zinc in malignant lymphoma. FUJITA MEDICAL JOURNAL 2022; 8:59-64. [PMID: 35520290 PMCID: PMC9069266 DOI: 10.20407/fmj.2021-006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/08/2021] [Indexed: 11/11/2022]
Abstract
Objectives Zinc (Zn) is a cofactor for more than 200 enzymes within the human body. Zn deficiency can result in cell-mediated immune dysfunction. Furthermore, serum Zn levels have been reported to be associated with nutritional status, but this association has not been clarified in malignant lymphoma. This study aimed to examine the deficiency of serum Zn levels and clarify the factors that are correlated with serum Zn in malignant lymphoma. Methods Initial malignant lymphoma was diagnosed in patients at Fujita Health University Hospital between April 2011 and March 2019. Based on the serum Zn levels, the study population was divided into "deficient" and "low or normal". For the serum Zn levels of patients undergoing pre-chemotherapy, laboratory parameters and nutritional factors were included. We compared these factors between the abovementioned two groups, and the serum Zn levels with its correlation factors were investigated. Results A total of 77 patients (Deficient group, n=20 and Low or Normal group, n=57) were enrolled. Histology, hemoglobin, serum albumin levels, Glasgow Prognostic Score (GPS), neutrophile-lymphocyte ratio (NLR), prognostic nutrition index (PNI) and Controlling Nutritional Status (CONUT) were significantly different between the two groups. Of these parameters, only serum albumin level was significantly associated with serum Zn level (p=0.0024; estimated regression coefficient, 9.51; adjusted coefficient of determination, 0.28). Conclusions Poor nutritional status at the initial diagnosis may have affected Zn deficiency in initial malignant lymphoma.
Collapse
Affiliation(s)
- Misaki Morisaku
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Kaori Ito
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
- Department of Hematology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Anna Ogiso
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Misa Imai
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yoshiko Hiraoka
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Miho Zennami
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Masahiro Tsuge
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Maiko Mori
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
- Department of Hematology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Seira Toyosato
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Hidezo Matsuda
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yosuke Ando
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Masutaka Tokuda
- Department of Hematology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Akihiro Tomita
- Department of Hematology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Shigeki Yamada
- Department of Clinical Pharmacy, Fujita Health University, School of Medicine, Toyoake, Aichi Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| |
Collapse
|
5
|
Bloom A, Bloom S, Silva H, Nicoll AJ, Sawhney R. Zinc supplementation and its benefits in the management of chronic liver disease: An in-depth literature review. Ann Hepatol 2022; 25:100549. [PMID: 34614431 DOI: 10.1016/j.aohep.2021.100549] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 02/04/2023]
Abstract
Malnutrition among patients with chronic liver disease (CLD) is a common complication with significant prognostic implications for patients with liver cirrhosis. Micronutrient deficiency has been associated with an increased risk of hepatic decompensation and is an independent risk factor for mortality among cirrhotic patients. Micronutrient deficiencies in patients with CLD include zinc, vitamin A, vitamin D and selenium. This review article aims to evaluate the literature to date on the complications of zinc deficiency in patients with CLD. A management algorithm for zinc replacement has also been proposed.
Collapse
Affiliation(s)
- Ashley Bloom
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Hannah Silva
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Nutrition and Dietetics, Eastern Health, Melbourne, Victoria, Australia
| | - Amanda J Nicoll
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Nutrition and Dietetics, Eastern Health, Melbourne, Victoria, Australia
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, 3 West, Building B, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria, Australia; Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
| |
Collapse
|
6
|
Serum Zinc Level Grading System: A Useful Model for Composite Hepatic Events in Hepatitis C Virus-Associated Liver Cirrhosis. J Clin Med 2020; 9:jcm9030643. [PMID: 32121095 PMCID: PMC7141206 DOI: 10.3390/jcm9030643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 02/08/2023] Open
Abstract
We aimed to clarify the impact of the serum zinc (Zn) level grading system proposed by the Japanese society of clinical nutrition (JSCN: 80 μg/dL < serum Zn level <130 μg/dL (type A), 60 μg/dL < serum Zn level <80 μg/dL (type B), and serum Zn level <60 μg/dL (type C)) in patients with hepatitis C virus (HCV)-related liver cirrhosis (LC) on the incidence of composite hepatic events (Com-HEs) compared with Child-Pugh (C-P) classification or albumin-bilirubin (ALBI) grade. (n = 275, median age = 67 years). The Akaike information criterion (AIC) was compared among three prognostic models. Factors associated with the incidence of Com-HEs were also studied. The first incidence of any HE was confirmed in 112 patients (40.7%). The AIC value for Com-HEs by the Zn level grading system was the lowest among the three prognostic models (AIC: 301.788 in Zn level grading system, 303.372 in ALBI grade, and 333.953 in C-P classification). In the multivariate analysis, male (p = 0.0031), ALBI grade 3 (p = 0.0041), type B (p = 0.0238), type C (p = 0.0004), and persistent viremia (p < 0.0001) were significant factors associated with the incidence of Com-HEs. In conclusion, the serum Zn level grading system proposed by JSCN can be helpful for estimating the incidence of Com-HEs in HCV-related LC patients.
Collapse
|