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Zinc Deficiency

Zinc deficiency is a condition, wherein the human body has insufficient quantities of zinc required to meet its daily needs. Such a type of nutritional deficiency can either be inherited, or acquired in nature.


Presentation

Individuals with zinc deficiency present with the following signs and symptoms [7] [8]:

Malnutrition
  • Malnutrition, prematurity, total parenteral nutrition dependence, and burns increase the demand for zinc, whereas congenital malabsorption syndromes represent clinical situations where less zinc is supplied to the growing child.[ncbi.nlm.nih.gov]
  • Severe depletion of zinc in two patients with advanced cancer and malnutrition was accompanied by cutaneous bleeding and laboratory findings of platelet dysfunction, both of which were corrected by oral supplementation of zinc and reoccurred on discontinuing[ncbi.nlm.nih.gov]
  • HarvestPlus program seeks to reduce micronutrient malnutrition among the poor by breeding staple food crops that are rich in micronutrients through a process called biofortification.[harvestzinc.org]
  • In areas where the prevalence of zinc deficiency or the prevalence of malnutrition is high, zinc may be of benefit in children aged six months or more.[ncbi.nlm.nih.gov]
  • Expanded and updated chapters on international nutrition, including protein energy malnutrition and community nutrition.[books.google.com]
Weight Loss
  • Besides prolonged diarrhea and weight loss, they showed manifestations such as infection, zinc deficiency, cholestasis, abnormal blood coagulation, etc. In this paper, we discuss whether they are causes, effects, results, or coincidences.[ncbi.nlm.nih.gov]
  • CASE REPORT: After undergoing vertical gastroplasty and jejunoileal bypass, a female patient presented marked weight loss and protein deficiency.[ncbi.nlm.nih.gov]
  • With the current prevalence of obesity and availability of surgical weight loss therapies, it is important to be mindful of the resulting nutritional deficiencies, their clinical manifestations, and factors affecting the efficacy of therapeutic approaches[ncbi.nlm.nih.gov]
  • Signs and symptoms caused by zinc deficiency are poor appetite, weight loss, and poor growth in childhood, delayed healing of wounds, taste abnormalities, and mental lethargy.[ncbi.nlm.nih.gov]
  • The manifestations of severe zinc deficiency include bullous pustular dermatitis, alopecia, diarrhea, emotional disorder, weight loss, intercurrent infections due to cell-mediated immune dysfunctions, hypogonadism in males, neurosensory disorders, and[ncbi.nlm.nih.gov]
Delayed Growth and Development
  • Individuals with zinc deficiency present with the following signs and symptoms: Delayed growth and development Fertility issues Diarrhea Unexplained weight loss Loss of appetite Development of several skin diseases, such as eczema, acne, alopecia, xerosis[symptoma.com]
Intravenous Drugs
  • The shortages of intravenous drugs remains critical, with sterile injectables accounting for 80% of the approximately 300 shortages.[ncbi.nlm.nih.gov]
Chronic Cough
  • No fever, weight loss, diarrhea, vomiting, abdominal pain, chronic cough, dyspnea, change in appetite, change in bowel habit, or urinary symptoms were noted.[ncbi.nlm.nih.gov]
Failure to Thrive
  • In addition, he manifested a failure to thrive and irritability. The diagnosis was confirmed by reduced serum levels of zinc (2.3 mumol/l) and alkaline phosphatase (45 U/l).[ncbi.nlm.nih.gov]
  • Links: acrodermatitis enteropathica diarrhoea alopecia failure to thrive taste disturbance[gpnotebook.co.uk]
  • […] to thrive Infections and allergic illness in offspring (e.g. diarrhoea, eczema) Childhood and Adolescence "Growing pains" in muscles and joints (Cu) Hyperactivity (Cu) Autism School phobia Eating dirt and strange substances (pica) Behavioural problems[adhd-support.org.uk]
  • Hair loss, nail dystrophy, failure to thrive and severe diarrhoea are also features. Atrophy of the brain cortex can lead to irritability and emotional disturbances. Secondary bacterial and fungal infections may also occur.[patient.info]
Dysgeusia
  • The serum Cu/Zn ratio was positively correlated with the both the SRT and the awareness of dysgeusia. The serum Zn concentration was not correlated with the SRT or the awareness of dysgeusia in univariate analyses.[ncbi.nlm.nih.gov]
  • Routine monitoring of zinc levels is hence unnecessary for asymptomatic patients after RYGB and should be reserved for patients with skin lesions, hair loss, pica, dysgeusia, hypogonadism or erectile dysfunction in male patients, and unexplained iron[ncbi.nlm.nih.gov]
  • J Clin Psychiatry 55, 309 – 311. 25 Heckmann, SM, Hujoel, P, Habiger, S, Friess, W, Wichmann, M, Heckmann, JG & Hummel, T ( 2005 ) Zinc gluconate in the treatment of dysgeusia – a randomized clinical trial.[doi.org]
  • Hypogeusia, dysgeusia, hyposmia, and dysosmia following influenza-like infection. Ann Otol Rhinol Laryngol 1975 ; 84 : 672 –8 21 Tomita, H, Ikeda, M, Okuda, Y. Basis and practice of clinical taste examinations.[doi.org]
  • Heckmann SM, Hujoel P, Habiger S, Friess W, Wichmann M, Heckmann JG & Hummel T (2005): Zinc gluconate in the treatment of dysgeusia—a randomized clinical trial. J. Dental Res. 84, 35–38.[doi.org]
Alopecia
  • Acral and periorificial dermatitis, diarrhea and alopecia were present in 15 cases (100%), 12 cases (80%) and 8 cases (53%) respectively.[ncbi.nlm.nih.gov]
  • The administration of zinc for zinc deficiency-related alopecia may recover appropriate activities of metalloenzymes, hedgehog signaling, and immunomodulation, all of which are required for normal control of hair growth cycle.[ncbi.nlm.nih.gov]
  • Follow-up in 4 months showed no evidence of alopecia, with normal-looking hair.[ncbi.nlm.nih.gov]
  • Zinc deficiency can be an autosomal recessive inherited or acquired disorder and is classically characterized by acral and periorificial dermatitis, alopecia, and diarrhea.[ncbi.nlm.nih.gov]
  • Cutaneous manifestations typically occur in moderate to severe zinc deficiency and present as alopecia and dermatitis in the perioral, acral, and perineal regions. Zinc deficiency is a potentially fatal disease process.[ncbi.nlm.nih.gov]
Eczema
  • Studies on Zinc Deficiency and Eczema Zinc Levels in Eczema A 2009 study published in the Turkish Journal of Dermatology investigated the serum levels of trace metals in patients with hand eczema.[progressivehealth.com]
  • The infants were both initially misdiagnosed as having eczema and infection.[ncbi.nlm.nih.gov]
  • […] of thighs (glossy skin) (A) Small bumps in skin of side and back of upper arm (A) Acne (A) Boils (A) Warts (A) Mouth ulcers (A) Sore tongue and mouth (B6) Cracks around mouth and split lips (B6) Leg ulcers (together with poor circulation) Dermatitis Eczema[adhd-support.org.uk]
  • Symptoms of Zinc Deficiency Behavioral and sleep disturbances Delayed wound healing Diarrhea Joint pain Dandruff Eczema Skin rashes Growth retardation Hair loss Hyperactivity Increased allergic sensitivity Inflammatory bowel disease Loss of appetite Mild[adoptionnutrition.org]
  • Individuals with zinc deficiency present with the following signs and symptoms: Delayed growth and development Fertility issues Diarrhea Unexplained weight loss Loss of appetite Development of several skin diseases, such as eczema, acne, alopecia, xerosis[symptoma.com]
Delayed Wound Healing
  • Clinical manifestations include growth retardation and male hypogonadism in adolescence, rough skin, poor appetite, mental lethargy, delayed wound healing, cell-mediated immune dysfunctions, and abnormal neurosensory changes.[ncbi.nlm.nih.gov]
  • Symptoms of Zinc Deficiency Behavioral and sleep disturbances Delayed wound healing Diarrhea Joint pain Dandruff Eczema Skin rashes Growth retardation Hair loss Hyperactivity Increased allergic sensitivity Inflammatory bowel disease Loss of appetite Mild[adoptionnutrition.org]
  • It is characterized by delayed wound healing and susceptibility to infection, growth detardation, fatigue, decreased alertness, a decrease in taste and odor sensitivity, poor appetite and delayed sexual maturity.[drugs.com]
  • You can have abdominal pain, loss of hair, loss of appetite, delayed wound healing,” Dr. Hadjiev says. “You can be depressed, you can have eczema or dermatitis, especially if it’s around the mouth or the anus.”[rd.com]
  • wound healing, (n) free radical damage, (o) frequent opportunistic infections, (p) scleroderma, (q) systemic scleroderma (including lethal pulmonary hypertension), (r) respiratory and skin allergies, (s) asthma, (t) premature aging, (u) loss of hair[coldcure.com]
Dry Skin
  • In 1958, a 21 year old male patient in the Iranian city of Shiraz presented with dwarfism, hypogonadism, hepatosplenomegaly, rough and dry skin, mental lethargy, geophagia, and iron deficiency anaemia. 1 This patient had an unusual diet.[bmj.com]
  • Brittle nails, white spots or white bands on fingernails Dandruff Decreased appetite Diarrhea Dry skin, prone to rashes Eye irritation or infections Failing Eyesight Anemia Hair Loss Hyperactive Infertility Insomnia Loss of sense of smell and/or taste[vitamins.lovetoknow.com]
  • Rough and dry skin iStock/PositiveFocus Experiencing skin conditions may also be a sign of zinc deficiency, particularly rashes. Moskovitz says if there are any suspicions you may be zinc deficient, you should consult with a primary care physician.[rd.com]
  • […] transverse lines and poor nail growth sleep and behavioral disturbances psychiatric illness all types of inflammatory bowel disease impaired glucose tolerance dandruff arthritis alcoholism loss of appetite growth retardation diarrhea tremor hair loss dry[diagnose-me.com]
Desquamating Rash
  • We report here a man who developed severe zinc deficiency, manifesting as a painful desquamative rash, due to an inability to obtain multi-trace element additives for his PN.[ncbi.nlm.nih.gov]
Night Blindness
  • In children or adults, manifestations also include alopecia, impaired immunity, anorexia, dermatitis, night blindness, anemia, lethargy, and impaired wound healing.[msdmanuals.com]
  • […] fingernails Dandruff Decreased appetite Diarrhea Dry skin, prone to rashes Eye irritation or infections Failing Eyesight Anemia Hair Loss Hyperactive Infertility Insomnia Loss of sense of smell and/or taste Memory Impairment Nail cuticle inflammation Night[vitamins.lovetoknow.com]
  • Night blindness can be another symptom. 7. Psychological disorders : Zinc deficiency could play a major role in depression. 8. Acne or rashes : People who have zinc deficiency can face various skin problems like rashes and acne.[food.ndtv.com]
  • Night blindness may be a feature of severe zinc deficiency, although most reports of night blindness and abnormal dark adaptation in humans with zinc deficiency have occurred in combination with other nutritional deficiencies (e.g. vitamin A).[en.wikipedia.org]
  • Children fail to gain weight and develop problems with walking and talking Men and women become infertile, and there can be impaired taste and smell, night blindness, and severe diarrhea.[healthifybody.com]
Psychiatric Symptoms
  • LIMITATIONS: This study does not provide a clear answer as to whether the observed differences represent a causal relationship between zinc deficiency and psychiatric symptoms.[ncbi.nlm.nih.gov]
  • Apart from depression, patients with dementia often present additional psychiatric symptoms and behavioral disturbances.[dx.doi.org]
Ataxia
  • For example, low serum zinc levels have been reported in Autism Spectrum Disorders (ASD), Attention deficit hyperactivity disorder (ADHD), Mood Disorders, such as depression, Schizophrenia (SCZ), and Spinocerebellar ataxia type 2 ( Pfaender and Grabrucker[dx.doi.org]
  • Neuropsychiatric signs include irritability, emotional instability, tremors, and occasional cerebellar ataxia. Weight loss, growth retardation, and male hypogonadism are also prominent clinical features.[ncbi.nlm.nih.gov]
Coarse Tremor
  • Infantile tremor syndrome is characterized by coarse tremors, mental and physical retardation, light colored brown hair, skin pigmentation and anemia.[ncbi.nlm.nih.gov]

Workup

Measuring the plasma levels of zinc, forms the preliminary basis of diagnosis. In infants with acroderatitis enteropathica, the plasma levels are as low as < 50 mcg/dL. Biopsy of the skin or intestinal mucosa is not indicated in diagnosing zinc deficiency [9]. In addition to plasma zinc levels, other studies that provide useful insight for diagnosing zinc deficiency, include urinary excretion of zinc and metabolic balance studies, measuring activities of enzymes that are dependent on zinc, zinc tolerance test and copper:zinc ratio.

Treatment

In patients with acrodermatitis enteropathica, supplementation of zinc gluconate or zinc sulfate is given at the rate of 1–3 mg/kg/d orally. Through the intravenous route, about 300–1000 mcg/kg/d would be enough for reversal of symptoms. Improvement in symptoms is observed within a period of 5 to 10 days. This should be accompanied, by topical application of petrolatum and warm compresses on areas that are weeping. Such a kind of therapy would promote re-epithelialization. In such cases, lifelong therapy may be necessary [10].

In addition to zinc supplementation, underlying causes of zinc deficiency should also be promptly treated. Individuals are also asked to include food sources of zinc in their daily diet. Dietary sources of zinc include red meat, crab, oysters, pulses, nut, legumes, cheese, fortified breakfast cereals and wholegrain cereals. Including these food sources in the diet, would compensate for losses in zinc [11].

Prognosis

Zinc deficiency can be corrected with appropriate therapy, which includes zinc supplementation. The prognosis of the condition is very favorable, when individuals are given zinc supplementation, depending on their age and physiological status. A survival rate of 100% can be achieved with proper therapy, and treatment in infants with acrodermatitis enteropathica [6].

Etiology

The acquired form of zinc deficiency is a common phenomenon. Whereas, the inherited form occurs as a result of inborn error in the zinc metabolism. This condition is referred to as acrodermatitis enteropathica. In addition, several other factors also contribute to zinc deficiency, which include improper intestinal absorption, insufficient dietary intake, increased loss and various factors that promote increased secretion of zinc from the body [2].

Epidemiology

It has been estimated that newborns suffering from acrodermatitis enteropathica, as a result of zinc deficiency, die within the first few years [3]. Zinc deficiency can affect individuals at any age. Males, as well as females, are equally susceptible to contract such a type of nutritional deficiency.

Zinc deficiency that occurs as a result of improper dietary intake, accounts for 25% of the cases. It is thought to be the leading cause of mortality amongst the infant population. Statistics have revealed that zinc deficiency caused about 176,000 deaths due to diarrhea, and 406,000 deaths due to pneumonia [4].

Sex distribution
Age distribution

Pathophysiology

Zinc is an essential mineral, which serves as an important element for various processes. About 60% of the total zinc content is found in the skeletal tissues, and the rest is found in the bone mass. Deficiency of the zinc also significantly produces loss in the epidermal Langerhans cells. In infants presenting with acrodermatitis enteropathica, a binding ligand goes missing, this significantly contributes to poor absorption of zinc from the breast milk. Genetic mutation in the mother, who is breastfeeding her child, is also known to contribute to development of acrodermatitis enteropathica. High concentration of phytates in certain food groups inhibits the absorption of zinc, favoring its deficiency to set in [5].

Prevention

For preventing zinc deficiency from setting in, individuals are advised to follow the 5 strategies, which include:

  • Agronomic biofortication, which consists of addition of zinc to the soil.
  • Fortification, a method which involves addition of zinc to various food sources.
  • Inclusion of zinc rich foods to daily diet.
  • Oral zinc supplementation to high risk groups, such as children and pregnant and lactating mothers.
  • Oral repletion using multivitamin or mineral supplements, which contain zinc sulfate or zinc gluconate.

Summary

Zinc is an essential mineral that is required for many body processes. It is necessary for the catalytic activity of approximately 100 enzymes. A daily intake of zinc is essential for maintenance of various processes; this is because, there is no mechanism by which the mineral can be stored in the body. Zinc is also important for immune response, and is also significantly associated with lymphocyte depletion, functioning of the phagocytes, and decreased production of interleukin [1].

Patient Information

  • Definition: Zinc deficiency is characterized by a condition; wherein there are lower than normal levels of zinc. This essential trace mineral is important for several body processes, and its deficiency can call for onset of several debilitating conditions. Zinc deficiency is associated with increased incidence of diarrhea, malaria and pneumonia.
  • Cause: Various factors contribute to the development of zinc deficiency. These include dietary deficiency, poor intestinal absorption, and increased utilization in conditions of pregnancy, infancy or periods of exercise. In addition to these factors, underlying chronic disease conditions also promote zinc deficiency to set in.
  • Symptoms: Zinc deficiency severely affects the mouth, skin, eyes, immune system, cognitive functioning and sense of taste and smell. One of the most important clinical manifestations of zinc deficiency includes the onset of acrodermatitis enteropathica amongst the infants. Individuals with zinc deficiency also suffer from growth retardation, poor cognitive functioning, hair loss, mouth sores, ulcers, xerosis, dermatitis, stomatitis and burning mouth syndrome.
  • Diagnosis: Measuring the plasma zinc levels helps in diagnosis of zinc deficiency. Along with evaluation of plasma levels of zinc, diagnostic methods would also include measuring the copper to zinc ratio, urinary excretion of zinc, metabolic balance studies, and measuring the activities of enzymes that are associated with zinc.
  • Treatment: Oral zinc supplementation is the most important method to treat zinc deficiency. Intravenous zinc administration is given in severe cases to reverse the symptoms. The inclusion of zinc rich foods in the daily diet is yet another way to improve the zinc status of the affected individuals.

References

Article

  1. Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr 1998; 68:447S.
  2. Prasad AS. Zinc: an overview. Nutrition. Jan-Feb 1995;11(1 Suppl):93-9.
  3. Wells BT, Winkelmann RD. Acrodermatitis enteropathica. Report of 6 cases. Arch Dermatol. Jul 1961;84:40-52.
  4. Hambidge M, Krebs N. Zinc, diarrhea, and pneumonia. J Pediatr 1999; 135:661.
  5. Bilinski DL, Ehrenkranz RA, Cooley-Jacobs J, et al. Symptomatic zinc deficiency in a breast-fed, premature infant. Arch Dermatol. Sep 1987;123(9):1221-4.
  6. Neldner KH, Hambidge KM. Zinc therapy of acrodermatitis enteropathica. N Engl J Med 1975; 292:879.
  7. Krebs NF. Update on zinc deficiency and excess in clinical pediatric practice. Ann Nutr Metab. 2013;62 Suppl 1:19-29.
  8. American Academy of Pediatrics Committee on Nutrition. Trace Elements. In: Pediatric Nutrition, 7th, Kleinman RE, Greer FR. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.467.
  9. Duggan C, MacLeod WB, Krebs NF, et al. Plasma zinc concentrations are depressed during the acute phase response in children with falciparum malaria. J Nutr 2005; 135:802.
  10. Portnoy B, Molokhia M. Acrodermatitis enteropathica treated by zinc. Br J Dermatol. Dec 1974;91(6):701-3.
  11. Veenemans J, Milligan P, Prentice AM, et al. Effect of supplementation with zinc and other micronutrients on malaria in Tanzanian children: a randomised trial. PLoS Med 2011; 8:e1001125.

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Last updated: 2019-07-11 21:50