Abstract
Beta thalassemia is a common monogenic hereditary hemoglobinopathy which is associated with compound complications. Zinc deficiency, which is commonly observed in thalassemia patients, is also associated with multiple health complications. The objective of this study was to determine the zinc status and its effect on the growth and immune functions of young beta thalassemia major patients. The study included 40 patients in comparison with age- and sex-matched 30 healthy individuals as controls. The patients were interviewed for socio-demographic variables, and their medical histories were obtained from the hospital files. Serum concentrations of zinc and ferritin, height, and body mass indices (BMI) were calculated. Mean serum zinc level in beta thalassemia major patients was 44.7 ± 24.2 μg/dl whereas in the control group it was 63.3 ± 30.3μg/dl. The mean serum zinc level is significantly low in beta thalassemia major patients with respect to the control group. The gender, age, duration of blood transfusion, blood transfusion volume, mean pretransfusion hemoglobin concentration, deferasirox dose, and serum ferritin level bear no relationship with serum zinc level of the beta thalassemia major patients. Zinc level showed no significant correlation with z-scores of stature, sitting height index, BMI, and frequency of recent infections of patients. Although zinc deficiency is common in beta thalassemia major patients, it was found to have no significant effect on physical growth and frequency of infections. Further studies are recommended to investigate zinc status of beta thalassemia major patients.
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De Silva S, Fisher CA, Premawardhena A, Lamabadusuriya SP, Peto TEA, Perera G, Old JM, Clegg JB, Olivieri NF, Weatherall DJ Sri Lanka Thalassaemia Study Group (2000) Thalassaemia in Sri Lanka: implications for the future health burden of Asian populations. Lancet 355(9206):786–791
Ministry of Health (1996) Annual health bulletin. Ministry of Health, Sri-Lanka, Colombo
Prasad AS (1995) Zinc: an overview. Nutrition 11(1 Suppl):93–99
Brown KH, Peerson JM, Rivera J, Allen LH (2002) Effect of supplemental zinc on the growth and serum zinc concentrations of pre-pubertal children: a meta-analysis of randomized controlled trials. Am J Clin Nutr 75:1062–1071
Jansen J, Karges W, Rink L (2009) Zinc and diabetes—clinical links and molecular mechanisms. J Nutr Biochem 20:399–417
Prasad AS (2009) Impact of the discovery of human zinc deficiency on health. J Am Coll Nutr 28:257–265
Cunningham MJ, Macklin E, Neufeld EJ, Cohen AR (2004) Complications of B-thalassemia major in North America. Blood 104:34–39
Yazdideha MS, Faranosh M (2004) Evaluation of serum zinc in children affected with beta-thalassemic patients. Res Med 24(1):7–9
Mahyar A, Ayazi P, Pahlevan AA, Mojabi H, Sehhat MR, Javadi A (2010) Zinc and copper status in children with beta-thalassemia major. Iran J Pediatr 20(3):297–302
Al-Samarrai AH, Adaay MH, Al-Tikriti KA, Al-Anzy MM (2008) Evaluation of some essential element levels in thalassemia major patients in Mosul district, Iraq. Saudi Med J 29(1):94–97
Mehdizadeh M, Zamani G, Tabatabaee S (2008) Zinc status in patients with major β-thalassemia. Pediatr Hematol Oncol 25(1):49–54
Maclean KH, Cleveland JL, Porter JB (2001) Cellular zinc content is a major determinant of iron chelator-induced apoptosis of thymocytes. Blood 98:3831–3839
Hettiarachchi M, Liyanage C, Wickremasinghe R, Hilmers DC, Abrahams SA (2006) Prevalence and severity of micronutrient deficiency: a cross-sectional study among adolescents in Sri Lanka. Asia Pac J Clin Nutr 15(1):56–63
Jayatissa R, Bekele A, Ekanayaka P, Ranbanda JM, Kumari Y (2015) Zinc deficiency in Sri Lanka: prevalence and risk factors. Eur J Nutr Food Saf 5(5):512–513
Marasinghe E, Chackrewarthy S, Abeysena C, Rajindrajith S (2015) Micronutrient status and its relationship with nutritional status in preschool children in urban Sri Lanka. Asia Pac J Clin Nutr 24(1):144–151
World Health Organization (2008) WHO child growth standards: training course on child growth assessment. World Health Organization, Geneva
World Health Organization (2007) Growth references. World Health Organization, Geneva
McDowell MA, Fryar CD, Ogden CL (2009) Anthropometric reference data for children and adults: United States, 1988–1994. Vital Health Stat 11(249):1–68
McDowell MA, Fryar CD, Ogden CL, Flegal KM. (2008) Anthropometric reference data for children and adults: United States, 2003–2006. National health statistics reports; no 10, National Center for Health Statistics, Hyattsville
Qi JX (1990) Determination of Cu, Zn, Fe, Ca, Mg, Na and K in serum flame by atomic absorption spectroscopy. In: AA Instruments At Work, AA-93. Varian 1–2
Hotz C, Peerson JM, Brown KH (2003) Suggested lower cut offs of serum zinc concentrations for assessing zinc status: reanalysis of the second National Health and Nutrition Examination Survey data (1976–1980). Am J Clin Nutr 78(4):756–764
World Health Organization (2002) World health report: Reducing risks, promoting health life, World Health Organization, Geneva
Erdoğan E, Canatan D, Ormeci AR, Vural H, Aylak F (2013) The effects of chelators on zinc levels in patients with thalassemia major. J Trace Elem Med Biol 27(2):109–111. https://doi.org/10.1016/j.jtemb.2012.10.002
Fung EB, Gildengorin G, Talwar S, Hagar L, Lal A (2015) Zinc status affects glucose homeostasis and insulin secretion in patients with thalassemia. Nutrients 7:4296–4307
Bartakke S, Bavdekar SB, Kondurkar P, Muranjan MN, Manglani MV, Sharma R (2005) Effect of deferiprone on urinary zinc excretion in multiply transfused children with thalassemia major. Indian Pediatr 42:150–154
Crisponi G, Nurchi VM, Crespo-Alonso M, Sanna G, Zoroddu MA, Alberti G et al (2015) A speciation study on the perturbing effects of iron chelators on the homeostasis of essential metal ions. PLoS ONE 10(7):e0133050. https://doi.org/10.1371/journal.pone.0133050
Kawchak DA, Schall JI, Zemel BS, Frempong KO, Stallings VA (2007) Adequacy of dietary intake declines with age in children with sickle cell disease. J Am Diet Assoc 107(5):843–848
Sherief LM, El-Salam SMA, Kamal NM, El Safy O, Almalky MAA, Azab SF, Morsy HM, Gharieb AF (2014) Nutritional biomarkers in children and adolescents with beta-thalassemia-major: an egyptian center experience. Biomed Res Int 8(4–5):490–495
Missiry MI, Hussein MH, Khalid S, Yaqub N, Khan S, Itrat F, Uderzo C, Faulkner L (2014) Assessment of serum zinc levels of patients with thalassemia compared to their siblings. Anemia 2014: vol 2014, p 6. http://doi.org/10.1155/2014/125452
Galanello R, Campus S (2009) Deferiprone chelation therapy for thalassemia major. Acta Haematol 122:155–164
Sultan S, Irfan SM, Kakar J, Zeeshan R (2015) Effect of iron chelator desferrioxamine on serum zinc levels in patients with beta thalassemia major. Malays J Pathol 37(1):35–38
Soliman AT, el Zalabany M, Amer M, Ansari BM (1999) Growth and pubertal development in transfusion-dependent children and adolescents with thalassaemia major and sickle cell disease: a comparative study. J Trop Pediatr 45(1):23–30
Fuchs GJ, Tienboon P, Linpisarn S, Nimsakul S, Leelapat P, Tovanabutra S, Tubtong V, DeWier M, Suskind RM (1996) Nutritional factors and thalassaemia major. Arch Dis Child 74(3):224–227
Arcasoy A, Cavdar A, Cin S, Erten J, Babacan E, Gözdasoglu S, Akar N (1987) Effects of zinc supplementation on linear growth in beta-thalassemia (a new approach). Am J Hematol 24(2):127–136
Aleem A, Shakoor Z, Alsaleh K, Algahtani F, Iqbal Z, Al-Momen A (2014) Immunological evaluation of β-thalassemia major patients receiving oral iron chelator deferasirox. J Coll Physicians Surg Pak 24(7):467–471
Consolini R, Calleri A, Legitimo A, Massei F (2001) Immunological evaluation of patients with beta-thalassemia major. Acta Haematol 105(1):7–12
Lombardi G, Matera R, Minervini MM, Cascavilla N, D’Arcangelo P, Carotenuto M, Di Giorgio G, Musto P (1994) Serum levels of cytokines and soluble antigens in polytransfused patients with b-thalassemia major: relationship to immune status. Haematologica 79(5):406–412
Cappellini MD, Cohen A, Eleftheriou A, Piga A, Porter J, Taher A (2008) Infections in thalassemia major. In: Guidelines for the clinical management of thalassemia, 2ndedn. Thalassemia International Federation. https://www.ncbi.nlm.nih.gov/books/NBK173965. Accessed 21 Sept 2017
Walker FC, Black RE (2004) Zinc and the risk for infectious disease. Annu Rev Nutr 24:255–275
Acknowledgements
We would like to thank Mr. JMNS Nawaratna, Mr. CN Perera, AMTSTM Bandara, and Mrs. PC Rajakaruna for their assistance in sample collection and laboratory analysis. Further gratitude goes to director and staff members of Peradeniya Teaching Hospital.
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All authors participated in the conception and design, acquisition of data, analysis and interpretation of data, and final approval of the version to be published. Attanayaka Mudiyanselage Dilhara Sewwandi Karunaratna drafted the article. Jamburagoda Gamage Shirani Ranasingha and Rasnayaka Mudiyanselage Mudiyanse participated in the critical revision of the article.
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Karunaratna, A.M.D.S., Ranasingha, J.G.S. & Mudiyanse, R.M. Zinc Status in Beta Thalassemia Major Patients. Biol Trace Elem Res 184, 1–6 (2018). https://doi.org/10.1007/s12011-017-1158-0
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DOI: https://doi.org/10.1007/s12011-017-1158-0