The Prevalence and Implication of Zinc Deficiency in Patients With Chronic Liver Disease

Kazuhiro Katayama, Takumi Kawaguchi, Koichi Shiraishi, Toshifumi Ito, Kazutomo Suzuki, Chizu Koreeda, Takaaki Ohtake, Motoh Iwasa, Yoshio Tokumoto, Ryujin Endo, Naohiro Kawamura, Makoto Shiraki, Tatsunori Hanai, Daiki Habu, Satoru Tsuruta, Hironori Sakai, Yoshiyuki Miwa, Norifumi Kawada, Akinobu Kato, Yoshiyuki Takei, Tetsuya Mine, Yutaka Kohgo, Toshihito Seki, Michio Sata, Yuri Ito, Keisuke Fukui, Shuhei Nishiguchi, Hisataka Moriwaki, Kazuyuki Suzuki


Background: Patients with liver cirrhosis often exhibit zinc deficiency. Although zinc is involved in many bioactivities, many aspects of clinical implications of zinc deficiency in liver cirrhosis remain unclear. We aimed to reveal the prevalence and implications of zinc deficiency in liver cirrhosis by assessing associations with parameters such as clinical symptoms and laboratory data.

Methods: In 235 cirrhosis patients enrolled at multiple medical institutions in 2009, we assessed how blood zinc levels were associated with their clinical symptoms, patients characteristics, and liver function test results.

Results: Blood zinc levels were most strongly correlated with blood albumin levels among the study parameters (r = 0.587, P < 0.0001). When blood albumin levels were ≤ 3.5 g/dL, blood zinc levels were < 70 μg/dL in 88% of patients. Additionally, significant correlations were observed with age (r = -0.253, P = 0.0014), aspartate aminotransferase levels (r = -0.254, P = 0.0020), total bilirubin levels (r = -0.222, P = 0.0053), prothrombin time (r = -0.255, P = 0.0029), branched-chain amino acid to tyrosine ratio (r = 0.357, P < 0.0001), Child-Pugh score (r = 0.469, P < 0.0001), ammonia levels (r = -0.246, P = 0.0028), and total cholesterol levels (r = 0.314, P < 0.0001). Blood zinc levels were significantly lower in patients with edema/ascites (P < 0.0001), those with hepatic encephalopathy (P = 0.0215), those receiving oral diuretics (P = 0.0045), and those receiving oral branched-chain amino acids (P < 0.0001) than in those without these conditions.

Conclusions: Zinc deficiency is prevalent in cirrhosis patients, whereas nitrogen metabolic disorders, particularly hypoalbuminemia, can be an indicator of zinc deficiency. Thus, cirrhosis patients exhibiting a nitrogen metabolic disorder should be examined for the presence of zinc deficiency.

J Clin Med Res. 2018;10(5):437-444


Liver cirrhosis; Nitrogen metabolism; Branched-chain amino acid; Ammonia; Albumin

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