Zinc deficiency in patients with chronic pancreatitis

Abstract

BACKGROUNDZinc is a key element in numerous proteins and plays an important role in essential cell functions such as defense against free radicals and DNA damage repair. Chronic pancreatitis (CP) is a chronic inflammation with progressive fibrosis of pancreas ultimately resulting in pancreatic exocrine insufficiency (PEI), which is associated with malnutrition. Studies analyzing zinc levels in patients with CP are sparse and lead to conflicting results.AIMTo investigate serum zinc levels in patients with CP of various etiologies.METHODSBetween October 2015 and March 2018, patients with a diagnosis of CP were identified and recruited from the Pancreatic Outpatient Clinic at the Karolinska University Hospital in Stockholm, Sweden. Demographic, clinical and laboratory data were analyzed. Etiology of CP was determined according to the M-ANNHEIM classification system into the following etiological subcategories: alcohol consumption, nicotine consumption, hereditary factors, efferent pancreatic duct factors and immunological factors. Pancreatic exocrine function was defined as normal (fecal elastase 1 > 200 μg/g), mildly reduced (100-200 μg/g) and severely reduced (fecal elastase 1 < 100 μg/g).RESULTSA total of 150 patients were included in the analysis. Zinc deficiency (< 11 μmol/L) was present in 39 (26.0%) of patients: 22 females and 17 males. In the group of patients with zinc deficiency, 76.7% of patients had an exocrine pancreatic insufficiency (FE-1 < 200 μg/g). Older age was significantly associated with low zinc levels. Following a univariate analysis, patients aged 60-69 and patients ≥ 70 years of age had a significantly higher prevalence of zinc deficiencies compared to patients < 40 years of age [OR: 3.8, 95%CI (1.08-13.4); P = 0.04]; [OR 6.26, 95%CI (1.94-20.2), P > 0.002]. Smoking and number of pack-years were additionally associated with low zinc levels. The risk of zinc deficiency in current smokers and smokers with ≥ 20 pack-years was approximately three times higher compared to those who had never smoked. Gender, body mass index, etiology of CP, presence of diabetes mellitus, levels of glycated hemoglobin (HbA1c), bone mineral density, alcohol intake and presence of PEI were not associated with low zinc levels.CONCLUSIONZinc deficiency is common in patients with CP and is significantly associated with age ≥ 60, smoking and the number of pack-years, but not with PEI.

European Guideline on IgG4‐related digestive disease – UEG and SGF evidence‐based recommendations

“…54 Deficiency of fat-soluble vitamins, namely magnesium, zinc, calcium, iron, haemoglobin, albumin, and prealbumin, have been associated with pancreatic insufficiency. 54,[63][64][65][66] Patients with all aetiologies of chronic pancreatitis, including those of autoimmune cause, are also at high risk of developing osteoporosis and osteopenia, especially in patients with glucocorticoid treatment. 54,67,68 Pancreatic duct stones were reported in 5-40% of patients with AIP.…”

Pathological Mechanisms in Diabetes of the Exocrine Pancreas: What’s Known and What’s to Know

“…In addition, insufficient secretion of pancreatic protease may cause vitamin B12 deficiency. Mineral intake and absorption are also affected in pancreatic disease ( Papazachariou et al, 2000 ; Vujasinovic et al, 2019 ). Several markers change significantly in patients with PEI, including albumin, phosphorus, and fat-soluble vitamins ( Alexandre-Heymann et al, 2019 ).…”

Chronic Pancreatitis and Nutrition Therapy

“…However, the risk of thiamin deficiency secondary to concomitant alcoholism should be considered. Mineral deficiencies of magnesium, zinc, copper, and selenium have been reported, and although supplementation of these is likely to be of benefit in chronic pancreatitis, intervention studies are warranted …”