Zinc metabolism in celiac disease

Crofton, R. W.; Aggett, Peter; Gvozdanovic, S.; Gvozdanovic, D.; Mowat, N. A. G.; Brunt, P. W.

doi:10.1093/ajcn/52.2.379

Cited by 32 publications

(22 citation statements)

References 19 publications

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“…Macrocytic anaemia in untreated CD-patients is usually caused by folate deficiency. In two large European studies, anaemia, mostly attributed to malabsorption, was reported to be present in 20%–34% of untreated CD-patients [20,30]. This corresponds with our results in which 25% of the CD-patients suffered from iron-deficiency anaemia.…”

Section: Discussionsupporting

confidence: 92%

Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients

et al. 2013

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Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B6, B12, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B6 14.5%, folic acid 20%, and vitamin B12 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B12. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.

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Section: Discussionsupporting

confidence: 92%

Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients

et al. 2013

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“…Comparable data on the effects of unabsorbed fat, specifically undigested fat, and zinc, and the effects on zinc homeostasis in conditions with fat malabsorption are extremely limited, particularly in infants. Increased endogenous losses have been suggested to occur in adults with celiac disease (29). Although these infants were young enough to have had some degree of physiologic steatorrhea, in metabolic studies in normal breastfed infants at a similar age, we have reported lower endogenous zinc losses and positive net absorption (10).…”

Section: Zinc Homeostasis In Cystic Fibrosissupporting

confidence: 44%

Abnormalities in Zinc Homeostasis in Young Infants with Cystic Fibrosis

et al. 2000

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Low plasma zinc concentrations have been reported in approximately 30% of young infants with cystic fibrosis identified by newborn screening. The objective of this study was to examine zinc homeostasis in this population by application of stable isotope methodology. Fifteen infants with cystic fibrosis (9 male, 6 female; 7 breast-fed, 8 formula-fed) were studied at a mean (ϮSD) age of 1.8 Ϯ 0.7 mo. On d 1, 70 Zn was administered intravenously, and 67 Zn was quantitatively administered with all human milk/formula feeds during the day. Three days later, a 3-d metabolic period was initiated, during which time intake was measured and complete urine and fecal collections were obtained. Fractional zinc absorption, total absorbed zinc, endogenous fecal zinc, and net absorbed zinc were measured; fecal fat excretion was also determined. Fractional absorption was significantly higher for the breast-fed infants (0.40 Ϯ 0.21) compared with the formula-fed group (0.13 Ϯ 0.06) (p ϭ 0.01), but with the significantly higher dietary zinc intake of the formula-fed group, total absorbed zinc was higher for those receiving formula (p ϭ 0.01). In 11 infants with complete zinc metabolic data, excretion of endogenous zinc was twofold greater for the formula-fed infants (p Ͻ 0.05); net absorption (mg zinc/d) was negative for both feeding groups: Ϫ0.04 Ϯ 0.52 for breast-fed; Ϫ0.28 Ϯ 0.57 for formula-fed. Endogenous fecal zinc losses correlated with fecal fat excretion (r ϭ 0.89, n ϭ 9, p ϭ 0.001), suggesting interference with normal conservation of endogenously secreted zinc. These findings indicate impaired zinc homeostasis in this population and suggest an explanation for the observations of suboptimal zinc status in many young infants with cystic fibrosis prior to diagnosis and treatment. The prevalence of zinc deficiency in individuals with cystic fibrosis has been an area of some uncertainty. Young infants, because of their rapid rates of growth, have relatively high physiologic zinc requirements. There have been several reports of young infants with cystic fibrosis presenting with signs and symptoms of severe zinc deficiency (1-3). Previous observations from the Colorado Newborn Screening Program suggested that zinc status was frequently suboptimal by 6 wk of age in infants found to have cystic fibrosis. Nearly 30% of subjects were found to have plasma zinc concentrations below the normal range, consistent with moderate zinc deficiency. In the same infants, treatment with pancreatic enzymes was associated with significant increases in plasma zinc concentrations (4). To investigate the potential underlying perturbations, we undertook detailed studies of zinc metabolism in these infants by the application of zinc stable isotope methodology.The objectives were to examine fractional absorption and fecal excretion of endogenous zinc according to type of feeding and degree of fat malabsorption. METHODS Study design.This was a cross-sectional study of zinc homeostasis in young infants with cystic fibrosis who were identified by newborn ...

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“…Zinc deficiency in patients with celiac disease is considered as being related with endogenous loss, rather than malabsorption (27). Several skin lesions are possible in zinc deficiency.…”

Section: Discussionmentioning

confidence: 99%

Vitamin and mineral deficiency in children newly diagnosed with celiac disease

Topal¹,

Çatal²,

Acar³

et al. 2015

Turk J Med Sci

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IntroductionCeliac disease is a chronic autoimmune disease that particularly affects the proximal small bowel (1). An autoimmune-mediated mechanism plays a part in the pathophysiology of the disease, and small bowel mucosal injury and malabsorption occur due to the hypersensitivity to gluten in prone individuals. Vitamin and mineral deficiency may also be seen depending upon malabsorption. Consequently, the clinical symptoms of the disease are not limited to the gastrointestinal system and may appear with a heterogeneous clinical spectrum involving the extraintestinal system. The typical symptoms of the disease include chronic diarrhea, abdominal distention, and growth retardation (2,3). However, the disease may also manifest itself with extraintestinal findings related to the hematologic, endocrine, and autoimmune systems. Anemia is the most frequently seen disorder in the hematologic system that often develops due to iron deficiency (4-9). Hypocalcemia and osteopenia may also occur due to vitamin D deficiency (10,11). No extensive study has been conducted regarding the vitamin and mineral deficiencies of pediatric patients diagnosed with celiac disease up to the present. Accordingly, it is the objective of this study to determine the frequency of vitamin A, D, and E deficiency, as well as zinc and mineral deficiencies, in pediatric patients diagnosed with celiac disease at the time of application to our clinic. Materials and methodsThe files of the patients diagnosed with celiac disease and followed in our Pediatric Gastroenterology, Hepatology, and Nutrition Clinic from June 2008 to June 2013 were reviewed retrospectively. Patients with complete file records and vitamin and mineral levels checked at the time of application were enrolled in the study. The demographic characteristics, complaints at the time of application, findings of duodenal biopsy, and serum 25 OH vitamin D, vitamin A, vitamin E, iron, and zinc levels of the patients were taken from the file records. The study was approved by the Ethics Committee of İnönü University (approval number 162/2013).The diagnosis of celiac disease was established in accordance with the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition's guidelines Background/aim: To establish the frequency of vitamin and mineral deficiency in children newly diagnosed with celiac disease. Materials and methods:The files of patients diagnosed with celiac disease in our Pediatric Gastroenterology Clinic from June 2008 to June 2013 were reviewed retrospectively.Results: A total of 52 pediatric patients diagnosed with celiac disease via serology and duodenal biopsy and who fulfilled the study criteria were enrolled in the study. The mean diagnosis age of the patients was 8.5 ± 3.9 years and 33 (63.5%) of the patients were female. Vitamin D, vitamin A, vitamin E, zinc, and iron deficiencies were determined in 27 (51.9%), 4 (7.7%), 7 (13.5%), 35 (67.3%), and 18 (34.6%) patients, respectively, at the time of diagnosis. Vitamin D deficiency was observed more frequent...

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Zinc metabolism in celiac disease

Cited by 32 publications

References 19 publications

Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients

Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients

Abnormalities in Zinc Homeostasis in Young Infants with Cystic Fibrosis

Vitamin and mineral deficiency in children newly diagnosed with celiac disease

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