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Zinc Deficiency

Zinc Deficiency is a topic covered in the 5-Minute Clinical Consult.

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  • Nutritional condition whose manifestations may involve growth retardation, hypogonadism, cell-mediated immune dysfunction, poor wound healing, poor appetite, hair loss, lethargy, increased incidence of infection, anorexia, diarrhea, and eye and skin lesions related to decreased zinc levels. Zinc is an integral component of >300 enzymes and 3,000 transcription factors and plays structural roles in the cell membrane and proteins. Zinc is essential for wound healing and anabolic processes (1,2,3,4,5).
  • System(s) affected: endocrine/metabolic, nervous, skin/exocrine, hematologic/oncologic, gastroenterologic
Geriatric Considerations
  • 5–35% of ambulatory elderly may have zinc-deficient diets (1,5).
  • Zinc deficiency may cause 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 (6)
  • Reactive oxygen species leading to inflammation are involved in many chronic diseases attributed to aging: atherosclerosis and coronary artery disease, Alzheimer disease, neurodegenerative disorders, diabetes mellitus type 2, and cancer (1,3).
  • Increased depression and poor cognitive function in the elderly are associated with low zinc levels.
  • Decreased immune function: Zinc supplementation in one study, elderly subjects decreased the incidence of infection (1)[B].
Pediatric Considerations
  • Zinc deficiency may cause failure to thrive and may impair growth and development of secondary sexual characteristics (3).
  • Peak requirements during pubertal growth spurt (ages 10 to 15 years old) (2)
  • Supplementing deficient children decreases mortality from diarrhea (7)[A] and pneumonia in certain populations (7)[B].
Pregnancy Considerations
  • Requirements increase; deficiency may cause spontaneous abortion, preterm labor. Supplementation in deficient individuals reduces preterm labor but does not improve birth weight (8)[A].
  • Severe deficiency is associated with congenital malformations and increased maternal morbidity.


  • Rare in the United States
  • Globally: Estimated 16% (1.1 billion people) are at risk for deficiency; 90% at risk live in Africa and Asia.
  • Highly correlated to per capita gross national income (9)
  • May be as high as 28% in hospitalized elderly patients
  • Estimated 5–35% in ambulatory elderly
  • Predominant age: all ages
  • Predominant sex: male = female

Etiology and Pathophysiology

  • Insufficient dietary intake
    • Diet lacking in animal proteins (dairy, eggs, meat, seafood)
    • Parenteral hyperalimentation without zinc supplementation
    • Breastfeeding (infants)
    • Alcoholism
    • Cystic fibrosis
  • Increased requirements
    • Pregnancy
    • Lactation
    • Rapid growth phase in childhood
    • Burns
    • Major trauma
    • Systemic illness resulting in oxidative stress
  • Increased losses
    • Diabetes
    • Cirrhosis
    • Renal disease
    • Dialysis
    • Inflammatory bowel disease, steatorrhea, enterostomy, fistula
    • Sickle cell disease
    • Diuretics: thiazides, chlorthalidone
  • Decreased absorption
    • Diet high in phytates (plant fiber)
    • Acrodermatitis enteropathica, an autosomal recessive deficiency in the enzyme required for intestinal absorption. These patients have bullous pustular dermatitis around oral, anal, genital orifices, thymic dysplasia, diarrhea, malabsorption, steatorrhea, and multiple repeat infections. It is fatal if untreated, although complete recovery possible with adequate supplementation.
    • Parasitism
    • Drugs: chelating agents, penicillamine, tetracyclines, quinolones, bisphosphonates

  • Usually acquired
  • Rarely caused by acrodermatitis enteropathica (autosomal recessive inheritance)
  • Associated with sickle cell anemia (autosomal recessive)

Risk Factors

  • Drugs: diuretics, penicillamine, sodium valproate, iron chelators, ACEI/ARB, cisplatin
  • Low socioeconomic status
  • Living in developing nations
  • Strict vegetarian diet
  • Malabsorption syndromes
  • Thermal burns
  • Alcoholism
  • Chronic renal failure

General Prevention

  • Adequate diet
  • Supplementation when indicated (see “Medication”)

Commonly Associated Conditions

  • Acrodermatitis enteropathica
  • Sickle cell anemia
  • Malabsorption
  • Advanced age
  • Diarrheal illness

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Stephens, Mark B., et al., editors. "Zinc Deficiency." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116658/all/Zinc_Deficiency.
Zinc Deficiency. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116658/all/Zinc_Deficiency. Accessed April 24, 2019.
Zinc Deficiency. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116658/all/Zinc_Deficiency
Zinc Deficiency [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116658/all/Zinc_Deficiency.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Zinc Deficiency ID - 116658 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116658/all/Zinc_Deficiency PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -