Skip to main content
×
Home

Indicators of zinc status at the population level: a review of the evidence

  • Rosalind S. Gibson (a1), Sonja Y. Hess (a2), Christine Hotz (a3) and Kenneth H. Brown (a2) (a4)
Abstract

The role of zinc deficiency as an important cause of morbidity and impaired linear growth has prompted the need to identify indicators of population zinc status. Three indicators have been recommended – prevalence of zinc intakes below the estimated average requirement (EAR), percentage with low serum zinc concentrations, and percentage of children aged < 5 years who are stunted. This review outlines steps to estimate the prevalence of inadequate intakes, and confirm their validity based on the EARs set by International Zinc Nutrition Collaborative Group. Next, the appropriateness of serum zinc as a biochemical marker for population zinc status is confirmed by a summary of: (a) the response of serum zinc concentrations to zinc intakes; (b) usefulness of serum zinc concentrations to predict functional responses to zinc interventions; (c) relationship between initial serum zinc and change in serum zinc in response to interventions. Height- or length-for-age was chosen as the best functional outcome after considering the responses of growth, infectious diseases (diarrhoea, pneumonia), and developmental outcomes in zinc supplementation trials and correlation studies. The potential of other zinc biomarkers such as zinc concentrations in hair, cells, zinc-metalloenzymes, and zinc-binding proteins, such as metallothionein, is also discussed. Molecular techniques employing reverse transcriptase (RT)-polymerase chain reaction to measure mRNA in metallothionein and ZIP1 transporter hold promise, as do kinetic markers such as exchangeable zinc pools (EZP) and plasma zinc turnover rates. More research is needed to establish the validity, specificity, sensitivity, and feasibility of these new biomarkers, especially in community-settings.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Indicators of zinc status at the population level: a review of the evidence
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Indicators of zinc status at the population level: a review of the evidence
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Indicators of zinc status at the population level: a review of the evidence
      Available formats
      ×
Copyright
Corresponding author
*Corresponding author: Rosalind S. Gibson, fax +64-3-479-7958 (Office), email Rosalind.Gibson@Stonebow.Otago.AC.NZ
References
Hide All
1Hotz C & Brown KH (2004) International zinc nutrition consultative group (IZiNCG) technical document #1. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull 25, S99S199.
2Gibson RS (2005) Principles of Nutritional Assessment, 2nd ed.New York: Oxford University Press.
3Zlotkin SH & Cherian MG (1988) Hepatic metallothionein as a source of zinc and cysteine during the first year of life. Pediatr Res 24, 326329.
4King JC (1990) Assessment of zinc status. J Nutr 120, 14741479.
5WHO/UNICEF/IAEA/IZiNCG (2007) Report of a WHO/UNICEF/IAEA/IZiNCG interagency meeting on zinc status indicators. Food Nutr Bull 28, S399S483.
6Houston MS, Summers SL & Soltesz KS (1997) Lifestyle and dietary practices influencing iron status in university students. Nutr Res 17, 922.
7Richardson NJ (1994) UK consumer perceptions of meat. Proc Nutr Soc 53, 281287.
8Lönnerdal B (2000) Dietary factors influencing zinc absorption. J Nutr 130, 1378S1383S.
9Donovan UM & Gibson RS (1995) Iron and zinc status of young women aged 14 to 19 years consuming vegetarian and omnivorous diets. J Am Coll Nutr 14, 463472.
10Hunt JR (2003) Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr 78, 633S639S.
11Ma J & Betts NM (2000) Zinc and copper intakes and their major food sources for older adults in the 1994–96 Continuing Survey of Food Intakes by Individuals (CSFII). J Nutr 130, 28382843.
12Smit-Vanderkooy P & Gibson RS (1987) Food consumption patterns of Canadian preschool children in relation to zinc and growth status. Am J Clin Nutr 45, 609616.
13Skinner JD, Carruth BR, Houck KS & Coletta F (1997) Longitudinal study of nutrient and food intakes of infants aged 2 to 24 months. JADA 97, 496505.
14Soh P, Ferguson EL, McKenzie JE, Skeaff S, Parnell W & Gibson RS (2002) Dietary intakes of 6–24 month-old urban South Island New Zealand children in relation to biochemical iron status. Public Health Nutr 5, 339346.
15IZiNCG (International Zinc Nutrition Collaborative Group) (2007 a) Determining the risk of zinc deficiency: assessment of dietary zinc intake. IZiNCG Technical Brief No. 03.
16Gibson RS & Ferguson EL (1999) An Interactive 24-h Recall Method for Assessing Intakes of Iron and Zinc in Developing Countries. Washington, DC: ILSI Press.
17Hotz C (2007) Dietary indicators for assessing the adequacy of population zinc intakes. Food Nutr Bull 28, S430S448.
18Gregory J, Low S, Bates CJ, Prentice A, Jackson LV, Smithers G, Wenlock R & Farron M (2000) National Diet and Nutrition Survey: young people aged 4 to 18 years. Volume 1: Report of the Diet and Nutrition Survey. London: The Stationery Office.
19WHO/FAO (World Health Organization/Food and Agriculture Organization) (2004) Vitamin and Mineral Requirements in Human Nutrition, 2nd ed. Geneva: World Health Organization.
20Hotz C, Lowe NM, Araya M & Brown KH (2003 a) Assessment of the trace element status of individuals and populations. The example of zinc and copper. J Nutr 133, 1563S1568S.
21Hambidge KM, Mazariegos M, Solomons NW, Westcott JE, Lei S, Raboy V, Grunwald G, Miller LV, Sheng X & Krebs NF (2007) Intestinal excretion of endogenous zinc in Guatemalan school children. J Nutr 137, 17471749.
22Liuzzi JP & Cousins RJ (2004) Mammalian zinc transporters. Ann Rev Nutr 24, 151172.
23Hess SY, Peerson JM, King JC & Brown KH (2007) Use of serum zinc concentration as an indicator of population zinc status. Food Nutr Bull 28, S403S429.
24Lowe NM, Woodhouse LR, Sutherland B, Shames DM, Burri BJ, Abrams SA, Turnland JR, Jackson MJ & King JC (2004) Kinetic parameters and plasma zinc concentrations correlated well with net loss and gain of zinc from men. J Nutr 134, 21782181.
25Gibson RS, Heath AL, Limbago ML, Prosser N & Skeaff CM (2001) Are changes in food consumption patterns associated with lower biochemical zinc status among women from Dunedin, New Zealand? Br J Nutr 86, 7180.
26USDA (US Department of Agriculture) (1998) Agriculture Research Service. Continuing Survey of Food Intakes by Individuals 1994–1996. National Technical Information Service CD-Rom 2002 (NTIS Accession no. PB2000-500027, 2002), 1998.
27Hotz C, Peerson JM & Brown KH (2003 b) Suggested lower cutoffs 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, 756764.
28Tran CD, Miller LC, Krebs NF, Lei S & Hambidge KM (2004) Zinc absorption as a function of dose of zinc sulfate in aqueous solution. Am J Clin Nutr 80, 15701573.
29Brown KH, Peerson JM, Rivera J & Allen LH (2002) Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: a meta-analysis of randomized controlled trials. Am J Clin Nutr 75, 10621071.
30Karr M, Mira M, Causer J, Earl J, Alperstein G, Wood F, Fett MJ & Coakley J (1997) Age-specific reference intervals for plasma vitamins A, E and beta-carotene and for serum zinc, retinol-binding protein and prealbumin for Sydney children aged 9–62 months. Int J Vitam Nutr Res 67, 432436.
31Van Biervliet S, Van Biervliet JP, Bernard D, Vercaemst R & Blaton V (2003) Serum zinc in healthy Belgian children. Biol Trace Elem Res 94, 3340.
32Lockitch G, Halstead AC, Wadsworth L, Quigley G, Reston L & Jacobson B (1988) Age- and sex-specific pediatric reference intervals and correlations for zinc, copper, selenium, iron, vitamins A and E, and related proteins. Clin Chem 34, 16251628.
33IZiNCG (International Zinc Nutrition Collaborative Group) (2007 b) Assessing population zinc status with serum zinc concentration. IZiNCG Technical Brief No. 02.
34Fischer Walker CL & Black RE (2007) Functional indicators for assessing zinc deficiency. Food Nutr Bull 28, S454S479.
35Hambidge KM (1982) Hair analyses: worthless for vitamins, limited for minerals. Am J Clin Nutr 32, 25322539.
36Yokoi E, Egger NG, Ramanujam VMS, Alcock NW, Dayal HH, Penland JG & Sandstead HH (2003) Association between plasma zinc concentration and zinc kinetic parameters in premenopausal women. Am J Physiol Endocrinol Metab 285, E1010E1020.
37Ruz M, Cavan KR, Bettger WJ & Gibson RS (1992) Erythrocytes, erythrocyte membranes, neutrophils and platelets as biopsy materials for the assessment of zinc status in humans. Brit J Nutr 68, 515527.
38Thompson RPH (1991) Assessment of zinc status. Proc Nutr Soc 50, 1928.
39Sachdev HP, Mittal NK & Yadav HS (1990) Oral zinc supplementation in persistent diarrhoea in infants. Ann Trop Paediatr 10, 6369.
40King JC, Shames DM, Lowe NM, Woodhouse LR, Sutherrland B, Abrams SA, Turnlund JR & Jackson MJ (2001) Effect of acute zinc depletion on zinc homeostasis and plasma zinc kinetics in men. Am J Clin Nutr 74, 116124.
41Pinna K, Woodhouse LR, Sutherland B, Shames DM & King JC (2001) Exchangeable zinc pool masses and turnover are maintained in healthy men with low zinc intakes. J Nutr 131, 22882294.
42Bales CW, DiSilvestro RA, Currie KL, Plaisted CS, Joung H, Galanos AN & Lin PH (1994) Marginal zinc deficiency in older adults: responsiveness of zinc status indicators. J Am Coll Nutr 13, 455462.
43Blostein-Fujii A, DiSilvestro RA, Frid D, Katz C & Malarkey W (1997) Short-term zinc supplementation in women with on-insulin-dependent diabetes mellitus: effects on plasma 5′ nucleotidase activity insulin-like growth factor I concentrations and lipoprotein oxidation rates in vitro. Am J Clin Nutr 66, 639642.
44Davis CD, Milne DB & Nielsen FH (2000) Changes in dietary zinc and copper affect zinc-status indicators of postmenopausal women, notably extracellular superoxide dismutase and amyloid precursor proteins. Am J Clin Nutr 71, 781788.
45Bales CW, DiSilvestro RA, Currie KL, Plaisted CS, Joung H, Galanos AN & Lin PH (1994) Marginal zinc deficiency in older adults: responsiveness of zinc status indicators. J Am Coll Nutr 13, 455462.
46Meftah S, Prasad AS, Lee DY & Brewer GJ (1991) Ecto 5′nucleotidase (5′NT) as a sensitive indicator of human zinc deficiency. J Lab Clin Med 118, 309316.
47Sunderman FW (1990) The clinical chemistry of 5′nucleotidase activity. Clin Chem 13, 903910.
48Grider A, Bailey LB & Cousins RJ (1990) Erythrocyte metallothionein as an index of zinc status in humans. Proc Natl Acad Sci USA 87, 12591262.
49Thomas EA, Bailey LB, Kauwell GA, Lee DY & Cousins RJ (1992) Erythrocyte metallothionein response of dietary zinc in humans. J Nutr 122, 24082414.
50Prasad AS, Meftah S, Abdallah J, Kaplan J, Brewer GJ, Bach JF & Dardenne M (1988) Serum thymulin in human zinc deficiency. J Clin Invest 82, 12021210.
51Allan AK, Hawksworth GM, Woodhouse LR, Sutherland B, King JC & Beattie JH (2000) Lymphocyte metallothionein mRNA responds to marginal zinc intake in human volunteers. Br J Nutr 84, 747756.
52Cao J & Cousins RJ (2000) Metallothionein mRNA in monocytes and peripheral blood mononuclear cells and in cells from dried blood spots increases after zinc supplementation of men. J Nutr 130, 21802187.
53Sullivan VK, Burnett FR & Cousins RJ (1998) Metallothionein expression is increased in monocytes and erythrocytes of young men during zinc supplementation. J Nutr 128, 707713.
54Saydam N, Adams TK, Steiner F, Schaffner W & Freedman J (2002) Regulation of metallothionein transcription by the metal-reponseive transcription factor MTF-1. J Biol Chem 227, 2043820445.
55Andree KB, Kim J, Kirschke CP, Gregg JP, Pail H-Y, Joung H, Woodhouse L, King JC & Huang L (2004) Investigation of lymphocyte gene expression for use as biomarkers for zinc status in humans. J Nutr 134, 17161723.
56Fenech M (2007) The cytokinesis-block micronucleus (CBMN) cytome assay as a bioefficacy biomaker for zinc status. http://www.fertilizer.org/ifa/publicat/PDF/2007_zinccrops2007_fenech.pdf (accessed Jan 2008).
57Miller LV, Hambidge KM, Naake VL, Hong Z, Westcott JL & Fennessey PV (1994) Size of the zinc pools that exchange rapidly with plama zinc in humams: alternative techniques for measuring and relation to dietary zinc intake. J Nutr 124, 268276.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 31
Total number of PDF views: 323 *
Loading metrics...

Abstract views

Total abstract views: 531 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th November 2017. This data will be updated every 24 hours.