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Low Levels of Serum Zinc Associate with Malnutrition Risk Assessed by the Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis

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Abstract

We have clarified that malnutrition risk evaluated by the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is prevalent in patients with cirrhosis. Mineral elements (zinc, iron, magnesium, copper, manganese, and calcium) are micronutrients essential for versatile physiological processes and cellular bioactivities. However, the association between these trace elements and integral nutritional status is unclear in decompensated cirrhotics. We collected blood samples from hospitalized patients with cirrhosis, and serum trace element concentrations were examined by inductively coupled plasma mass spectrometry. Association of trace element levels with high malnutrition risk was determined by multivariate logistic regression model. Sera from 141 patients with decompensated cirrhosis were analyzed for a total of six trace element concentrations. No significant differences were observed between high and low/moderate RFH-NPT malnutrition risk groups with the exception of zinc. The serum zinc concentrations were significantly decreased in patients at high malnutrition risk when compared to low/moderate subjects (57.9 vs 68.1 μg/dL, P = 0.006). In terms of receiver operating characteristics curve, zinc < 64 μg/dL represented best discriminative capability with an area of 0.635 (95% CI: 0.542, 0.728). Patients in the group with zinc < 64 μg/dL had elevated RFH-NPT and MELD score, higher proportion of Child–Pugh class C and ascites, higher CRP, lower albumin and sodium than in the group with zinc ≥ 64 μg/dL. Zinc < 64 μg/dL was an independent risk factor for high malnutrition risk. Low levels of serum zinc referring to less than 64 μg/dL were associated with poor integral nutritional status in cirrhosis.

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Funding

This work was partly supported by the Science and Technology Program of Tianjin (Grant 19ZXDBSY00020) to K. Jiang.

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Author notes

  1. Wanting Yang and Xiaoyu Wang contributed equally to this work

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, 300052, China

    Wanting Yang, Xiaoyu Wang, Zihan Yu, Chaoqun Li, Mingyu Sun, Yifan Li, Yangyang Hui, Gaoyue Guo, Xiaofei Fan, Kui Jiang & Chao Sun

  2. Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Anshan Road 154Heping District, Tianjin, 300052, China

    Wanting Yang, Xiaoyu Wang, Zihan Yu, Mingyu Sun, Yifan Li, Yangyang Hui, Gaoyue Guo, Xiaofei Fan, Kui Jiang & Chao Sun

  3. Department of Internal Medicine, Tianjin Hexi Hospital, Qiongzhou Road 43, Hexi District, Tianjin, 300202, China

    Chaoqun Li

  4. Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, East Street 6, Tianjin Airport Economic Area, Tianjin, 300308, China

    Chao Sun

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  1. Wanting Yang
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Contributions

W.T. Yang, X.Y. Wang, Z.H. Yu, and C. Sun: conceptualization, data analysis, statistics, and drafting manuscript. C.Q. Li, M.Y. Sun, and Y.F. Li: data analysis contribution. Y.Y. Hui and H.J. Feng: performing laboratory tests. G.Y. Guo and X.F. Fan: data analysis contribution. K. Jiang: providing valid criticism. All the authors discussed the data and approved the final version of the manuscript.

Corresponding author

Correspondence to Chao Sun.

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The present study was implemented following the Declaration of Helsinki and was approved by the Ethics Committee of TJMUGH.

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Yang, W., Wang, X., Yu, Z. et al. Low Levels of Serum Zinc Associate with Malnutrition Risk Assessed by the Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis. Biol Trace Elem Res 200, 4289–4296 (2022). https://doi.org/10.1007/s12011-021-03033-1

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