- Nutritional condition whose manifestations may involve growth retardation, decreased bone mineralization, hypogonadism, cell-mediated immune dysfunction, poor wound healing, poor appetite, hair loss, lethargy, increased infections, anorexia, diarrhea, and eye and skin lesions
- Zinc is a mineral and integral component of >300 enzymes and 3,000 transcription factors and plays structural role in cell membranes and proteins. Zinc is essential for wound healing and anabolic processes (1,2,3).
- System(s) affected: endocrine/metabolic, nervous, skin/exocrine, hematologic/oncologic, gastroenterologic, musculoskeletal
- 30–40% of ambulatory elderly may have zinc-deficient diets; elderly may also have decreased absorption (1,2).
- Zinc deficiency may cause delayed wound healing, chronic ulcers, and impaired recovery from infections. Poor night vision may contribute to increased falls/accidents; loss of taste, which may contribute to worsening nutrition (4)
- Reactive oxygen species leading to inflammation are involved in many chronic diseases attributed to aging: atherosclerosis, Alzheimer disease, neurodegenerative disorders, diabetes mellitus type 2, and cancer (1).
- Increased depression and poor cognitive function in the elderly are associated with low zinc levels.
- Supplementation in one study with elderly subjects decreased the incidence of infection (1)[B].
- Zinc deficiency may cause failure to thrive and may impair growth and development of secondary sexual characteristics (1).
- Peak requirement during pubertal growth spurt (ages 10 to 15 years old) (2)
- Supplementing deficient children decreases mortality from diarrhea (5)[A] and pneumonia in certain populations (2,5)[B].
Etiology and Pathophysiology
- Insufficient dietary intake
- Diet lacking in animal proteins (dairy, eggs, meat, seafood)
- Parenteral nutrition without zinc supplementation
- Breastfeeding (infants)
- Restricted eating/eating disorder
- Increased requirements
- Preterm infants
- Rapid growth phases in childhood
- Major trauma
- Systemic illness resulting in oxidative stress
- Increased losses
- Cirrhosis, alcoholism
- Renal disease, dialysis
- Steatorrhea, enterostomy, fistula
- Sickle cell disease
- Diuretics: thiazides, chlorthalidone, ACEI, ARB
- Decreased absorption
- Diet high in: phytates (plant fiber), cadmium, copper, iron
- Acrodermatitis enteropathica: autosomal recessive deficiency in the enzyme required for intestinal absorption of zinc
- Liver or pancreas dysfunction
- Inflammatory bowel disease
- After bariatric surgery
- Medications: chelating agents, penicillamine, tetracyclines, quinolones, bisphosphonates, valproate
- Usually an acquired deficiency
- Rarely caused by acrodermatitis enteropathica
- Associated with sickle cell anemia
- Medications: diuretics, penicillamine, valproate, iron chelators, ACEI/ARB, cisplatin
- Low socioeconomic status
- Living in developing nations
- Strict vegetarian diet
- Malabsorption syndromes
- Thermal burns
- Chronic renal failure
- Diverse and adequate diet
- Supplementation when indicated (see “Medication”)
Commonly Associated Conditions
- Acrodermatitis enteropathica
- Sickle cell anemia
- Advanced age
- Diarrheal illness, especially in children
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