Avaliação do status de zinco considerando diferentes combinações de componentes na síndrome metabólica / Zinc status assessment considering different combinations of components in metabolic syndrome

Introdução: Fatores cardiometabólicos característicos da síndrome metabólica (SM) influenciam no metabolismo do zinco, de forma isolada ou conjuntamente. Objetivo: Comparar as concentrações de zinco no plasma e na dieta entre os três de grupos de indivíduos com SM, distribuídos conforme número de componentes da SM. Métodos: Estudo transversal incluindo 88 indivíduos com SM, diagnosticados segundo NCEP-ATP III. Definiu-se os grupos, considerando três (n=36), quatro (n=40) e cinco componentes da SM (n=12). O zinco da dieta foi avaliado por dois recordatórios de 24h. Verificou-se a pressão arterial, perímetro da cintura e glicemia de jejum, colesterol da lipoproteína de alta densidade e triglicerídeos. O zinco no plasma foi avaliado por espectrofotometria de absorção atômica. As comparações entre os grupos foram realizadas por meio do teste ANOVA, seguido do teste Tukey. Resultados e discussão: A idade média foi de 50(11) anos, predominando o sexo feminino (72%). Observou-se no grupo com três componentes, dez diferentes fenótipos, destacando- se a combinação: hipertensão arterial ou pressão arterial elevada, diabetes mellitus ou glicemia de jejum elevada e perímetro da cintura aumentado (11,4%). Não foram verificadas diferenças significativas do zinco no plasma entre os grupos com três, quatro e cinco componentes, apresentando médias de 92,62(18,26) μg/dL; 86,24(17,88) μg/dL; 86,94(17,12) μg/dL, respectivamente (p>0,05). Constataramse percentuais de inadequação de ingestão de zinco de 75%, 73,6% e 66,6% nos grupos com três, quatro e cinco componentes, respectivamente. Conclusão: Indivíduos com SM, independentemente do número de componentes, apresentam médias de zinco no plasma dentro da normalidade e baixa ingestão de zinco na dieta

Introduction: Cardiometabolic risk factors characteristic of the metabolic syndrome (MS) influence zinc metabolism, either alone or in combination. Objective: This study aims to compare plasma zinc and zinc intake among the three groups of individuals with MS, distributed according to the number of components of SM. Methods: Cross-sectional study including 88 individuals with MS, diagnosed according to NCEP-ATP III. The groups were defined, considering three (n = 36), four (n = 40) and five components of MS (n = 12). Zinc intake was evaluated by two 24-hour recall. Blood pressure, waist circumference and fasting glycemia, high density lipoprotein cholesterol and triglycerides were measured. Analysis of plasma zinc was performed by atomic absorption spectrophotometry. We used ANOVA, followed by the Tukey test, for comparisons between the groups. Results and discussion: The mean age was 5011 years, predominantly female (72%). We found ten different phenotypes based on the three components of MS, with emphasis on the phenotype: arterial hypertension or high blood pressure, diabetes mellitus or fasting blood glucose and increased waist circumference (11.4%). There were no significant differences in plasma zinc between the groups with three, four and five components, presenting a mean of 92.62 (18.26) μg / dL; 86.24 (17.88) μg / dL; 86.94 (17.12) μg / dL, respectively (p> 0.05). The percentages of zinc intake inadequacy were 75%, 73.6% and 66.6% in the groups with three, four and five components, respectively. Conclusion: Individuals with MS, regardless of the number of components, present mean plasma zinc within normal range and low dietary zinc intake

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Dietary intake and zinc status in amyotrophic lateral sclerosis patients / Ingesta dietética y estado de zinc en pacientes con esclerosis lateral amiotrófica

Background: There is considerable evidence that abnormal zinc homeostasis is related to amyotrophic lateral sclerosis (ALS) pathogenesis, and malnutrition is an independent prognostic factor for worsened survival of ALS patients. Objective: To evaluate the dietary intake and zinc status in patients with ALS, treated in a specialized outpatient facility in Natal, Brazil. Methods: Twenty patients with ALS (case group) and 37 healthy subjects (control group) were included. Clinical and anthropometric assessments were carried out and dietary intake was obtained from two 24-hour recalls. Plasma and urinary zinc concentrations were determined by atomic absorption spectrophotometry. Results: Most of the participants were eutrophic. Mean energy, protein, carbohydrate and fat intake was significantly lower for the case group. There was greater prevalence of inadequate zinc intake in the case group (35%) compared to controls (27%). Mean plasma zinc was significantly lower in the case group than in controls (77.13 ± 22.21 vs 87.84 ± 17.44 μgZn/dl). Urinary zinc did not differ significantly between cases and controls. In the case group, plasma and urinary zinc concentrations were below reference values in 50.0% and 52.6% of patients, respectively. Conclusion: A large portion of patients with ALS exhibited poor dietary intake and changes in body zinc status. The zinc deficiency found in half of the ALS patients may contribute to a worsened prognosis and should be the target of nutritional intervention that aims to correct this deficiency (AU)

Introducción: hay pruebas considerables de que los cambios en la homeostasis del zinc están relacionados con la patogénesis de la esclerosis lateral amiotrófica (ELA) y que la malnutrición es un factor pronóstico capaz de reducir la supervivencia de los pacientes con ELA. Objetivo: evaluar la ingesta dietética y el estado de zinc en pacientes con ELA, tratados en un centro de atención ambulatoria especializado en Natal, Brasil. Métodos: se incluyeron 20 pacientes con ELA (grupo de casos) y 37 sujetos sanos (grupo control). Se realizaron evaluaciones clínicas y antropométricas y se obtuvo la ingesta dietética en dos recordatorios de 24 horas. Las concentraciones plasmáticas y urinarias de zinc se determinaron por espectrofotometría de absorción atómica. Resultados: la mayoría de los participantes fueron eutróficos. El consumo medio de energía, proteínas, carbohidratos y grasas fue significativamente menor en el grupo de casos. Hubo una mayor prevalencia de ingesta inadecuada de zinc en el grupo de casos (35%) en comparación con los controles (27%). El zinc plasmático medio fue significativamente menor en el grupo de casos que en los controles (77,13 ± 22,21 frente a 87,84 ± 17,44 μgZn/dl). El zinc urinario no difirió significativamente entre los casos y los controles. En el grupo de casos, las concentraciones de zinc plasmático y urinario fueron inferiores a los valores de referencia en el 50,0% y 52,6% de los pacientes, respectivamente. Conclusión: gran parte de los pacientes con ELA exhibieron una ingesta dietética pobre y modificación en el estatus de zinc corporal. La deficiencia de zinc encontrada en la mitad de los pacientes con ELA puede contribuir a un empeoramiento del pronóstico y debe ser el objetivo de la intervención nutricional que apunta a corregir esta deficiencia (AU)

Anti-inflammatory effects of zinc in PMA-treated human gingival fibroblast cells

OBJECTIVES: Abnormal cellular immune response has been considered to be responsible for oral lesions in recurrent aphthous stomatitis. Zinc has been known to be an essential nutrient metal that is necessary for a broad range of biological activities including antioxidant, immune mediator, and anti-inflammatory drugs in oral mucosal disease. The objective of this study was to investigate the effects of zinc in a phorbol-12-myristate-13-acetate (PMA)-treated inflammatory model on human gingival fibroblast cells (hGFs).Study DESIGN: Cells were pre-treated with zinc chloride, followed by PMA in hGFs. The effects were assessed on cell viability, cyclooxygenease-1,2(COX-1/2) protein expression, PGE2 release, ROS production and cytokine release, RESULTS: The effects were assessed on cell viability, COX1/2 protein expression, PGE2 release, ROS production, cytokine release. The results showed that, in the presence of PMA, zinc treatment leads to reduce the production of ROS, which results in decrease of COX-2 expression and PGE2 release. CONCLUSIONS: Thus, we suggest that zinc treatment leads to the mitigation of oral inflammation and may prove to be an alternative treatment for recurrent aphthous stomatitis

Enfermedad de Wilson: espectro clínico de la enfermedad hepática / No disponible

La enfermedad de Wilson es un trastorno hereditario autosómico recesivo del metabolismo del cobre (gen ATP7B), que se caracteriza por la acumulación del mismo en diferentes órganos, principalmente el hígado y el cerebro. Es una enfermedad poco frecuente, difícil de diagnosticar en muchas ocasiones y con un espectro clínico muy amplio y, por lo tanto, debemos sospecharla siempre en un paciente con hepatopatía de causa no clara. En el siguiente artículo presentamos 2 pacientes con diferentes formas de manifestación de la enfermedad hepática, uno de ellos requirió trasplante hepático urgente por fallo hepático fulminante y el otro recibió tratamiento médico. El objetivo de esta observación clínica es analizar el diagnóstico de la enfermedad de Wilson en 2 pacientes en los que se inició de forma diferente y, por tanto, el amplio espectro clínico de la enfermedad y su tratamiento (AU)

Wilson’s disease is a hereditary autosomal recessive disorder of copper metabolism, characterized by copper accumulation in the liver and brain. This rare entity, which has abroad clinical spectrum, is often difficult to diagnose and should therefore always be suspected in patients with liver disease of unclear cause. We describe two types of manifestation of liver disease in two patients; the first developed fulminant hepatic failure requiring urgent liver transplantation and the second showed advanced chronic liver disease and received standard medical treatment. The objective of this clinical observation is to analyze the diagnosis of Wilson’s disease in two patients with distinct onset, illustrating the broad clinical spectrum of the disease, and its treatment (AU)

Toxicidad aguda por cinc en Cnesterodon decemmaculatus (Pisces: Poeciliidae) y aplicación del Modelo de Ligando Biótico en agua del Río Pilcomayo (Sudamérica) / Acute zinc toxicity to Cnesterodon decemmaculatus (Pisces: Poeciliidae) and application of the Biotic Ligand Model in Pilcomayo River water (South America)

El Modelo del Ligando Biótico (BLM) es un modelo basado en el equilibrio químico. Incorpora el efecto de las características físico-químicas del agua en la biodisponibilidad y toxicidad de los metales sobre la biota acuática. Ha sido desarrollado para cuatro metales (Cu, Zn, Ag, Cd), dos especies de peces y tres de dáfnidos. Se asume que sus predicciones podrían ser extrapoladas a especies similares. En este estudio, se evaluó una posible extrapolación inter-especifica (peces) del BLM desarrollado para el zinc en agua del río Pilcomayo. Se llevó a cabo un ensayo de toxicidad aguda del zinc en el pez nativo Cnesterodon decemmaculatus. Las concentraciones de zinc disuelto aplicadas fueron: 0,13; 3,74; 9,2; 21,6 y 26,4 mg Zn L-1. La concentración letal media del zinc (CL50 96-h) calculada para C. decemmaculatus fue 22,6 mg Zn L-1 (17,5 - 27,6) y la predicha por el BLM para Pimephales promelas en el agua experimental fue 1,71 mg L-1. Las concentraciones de zinc medidas excedían la solubilidad del metal lo que produjo la precipitación del mismo, derivando en una 96-h CL50 que muy probablemente incluyó tanto especies de zinc disueltas como precipitadas. Sin embargo, las estimaciones de la especiación mostraron que la especie química del zinc más abundante en todos los tratamientos fue el ion libre. La mayor proporción de zinc en su forma iónica libre explicaría el bajo efecto protector de la elevada dureza del agua experimental. La diferencia entre la toxicidad del zinc observada y la predicha por el BLM podría deberse a la combinación de inexactitud en las mediciones de zinc disuelto y una menor sensibilidad de la especie experimental a la presencia de elevadas concentraciones de zinc (AU)

The Biotic Ligand Model (BLM) is a chemical equilibrium-based model that incorporates the effect of physicochemical water characteristics on the bioavailability and toxicity of metals to aquatic biota. It was developed for four metals (Cu, Zn, Ag and Cd), two fish species and three daphnids. It is assumed that its predictions can be extrapolated between similar species. In this study, a cross-fish-species extrapolation of the BLM developed for zinc (Zn-BLM) was assessed in Pilcomayo River water. An acute zinc toxicity test was performed to assess zinc toxicity to the local fish Cnesterodon decemmaculatus. The dissolved zinc concentrations tested were:3.74;9.2; 21.6 and 26.4 mg Zn L-1. The median letal zinc concentration (96-h Zn LC50) calculated for C. decemmaculatus was 22.6 mg Zn L-1 (17.5-27.6) and the predicted by Zn-BLM for Pimephales promelas in the test water was 1.71 mg L−1. Zinc concentrations measured exceeded zinc solubility causing metal precipitation which derived in a 96-h LC50 that most probably included both dissolved and precipitated zinc species. Nevertheless, speciation estimates showed that the more abundant zinc species in each treatment was the free ion. This higher proportion of zinc in its free ionic form would explain the low protective effect exerted by elevated water hardness. The difference between the observed zinc toxicity to C. decemmaculatus and the predicted by BLM for P. promelas may be due to the combination of inaccuracy in zinc dissolved measurements and a lower sensitivity of C. decemmaculatus to zinc exposure (AU)

Enfermedad pulmonar y afectación ungueal / Lung disease and nail-bed involvement

El síndrome de las uñas amarillas es una entidad poco frecuente caracterizada por la tríada de uñas amarillas, afectación pleuropulmonar y linfedema primario. Su origen aún no está aclarado pero se sugiere una alteración del retorno linfático como causa de todas sus manifestaciones. Presentamos este caso por la importancia que puede tener diagnosticar este síndrome y descartar posibles procesos patológicos asociados (neoplasias, VIH, tuberculosis, enfermedad tiroidea, artritis reumatoide), ya que es fácil llegar al diagnóstico si se conocen los signos cardinales, sobre todo la típica afectación ungueal (uñas amarillas y detención del crecimiento ungueal). En el tratamiento de este síndrome se han propuesto muchas alternativas, incluido el itraconazol oral, la vitamina E o los suplementos de cinc, pero la baja prevalencia de la enfermedad y la posibilidad de curación espontánea hacen que sea difícil evaluar la verdadera eficacia de las diferentes medidas terapéuticas (AU)

Yellow nails syndrome is a rare disease characterised by a triad of, yellow nails, pleural and lung involvement and primary lymphoedema. Its origin still remains unclear, but lymphatic return disturbance has been suggested as the reason of all its signs. We present this case because of the importance of diagnosing this syndrome and to rule out other associated diseases (malignancies, HIV, tuberculosis, thyroid disease, rheumatoid arthritis) as the diagnosis of the disease is easy if cardinal signs are known, particularly the condition of the nails (yellow nails and halted nail growth). Many possibilities have been proposed on the treatment of this syndrome,including, oral itraconazole, oral vitamin E, and zinc supplements, but the low prevalence of the disease and the possibility of spontaneous healing makes it difficult to evaluate the real effectiveness of the different treatments (AU)

Influencia del zinc administrado a pacientes críticos con nutrición parenteral sobre los niveles de zinc plasmático, proteína C reactiva, interleuquina-6 y receptor soluble de interleuquina-6 / Influence of zinc administered by total parenteral nutrition on plasmatic zinc levels, on reactive C protein, on serum interleukin-6 and on serum interleukin-6 soluble receptor, in critical patients

Objetivos: Estudiar, en pacientes críticos, la respuesta de los niveles de Zn en plasma (ZnPl), de IL-6 sérica, del IL-6sR y de la PCR en relación al Zn administrado en la NPT, para evitar la deficiencia o el exceso de Zn. Métodos: 17 pacientes que recibieron NPT, por pancreatitis aguda o luego de una cirugía abdominal mayor. Al inicio (To) y a la finalización (Tf) de la NPT (6 a 21 días) se determinó en suero: IL-6 y IL-6 sR (ELISA); PCR (inmunoturbidimetría); ZnPl y Zn en NPT (Espectrometría de Absorción Atómica). Características físicas: edad, años (promedio ± DE y rangos): 60,6 ± 11,7 (37-77); BMI (kg/m2): 26,0 ± 3,4 (19,9-34,0). Resultados: Promedio ± DE (y rangos): aporte de Zn en la NPT: 6,1 ± 2,0 mg/día (2,8 a 10,8); parámetros bioquímicos, a To y Tf, respectivamente: Zn Pl (μg/dl): 104 ± 46 (35-177); 120 ± 55 (52-229); IL-6 (pg/mL) 93 ± 74 (10-262); 117 ± 180 (7-761); IL6sR (pg/mL): 1012 ± 322 (589-1.855); 1.269 ± 451 (631-2.195); PCR (mg/L): 71 ± 63 (2-196); 65 ± 43 (0-137). Dos pacientes, que fallecieron, incrementaron más de 4 veces los niveles de IL6, mantuvieron altos niveles de IL-6sR, pero disminuyendo los de PCR, recibiendo 4,2 y 5,2 mg/d de Zn. El 60% de los pacientes con evolución clínica favorable presentó una disminución de los niveles de IL6. Conclusiones: en los pacientes críticos, con evolución favorable, dosis de Zn de 2,8 a 10,8 mg/d en la NPT no exacerbaron la respuesta inflamatoria, evaluada mediante los niveles de IL-6, IL6sR y PCR (AU)

Objectives: To study the interrelationship between serum Interleukin-6 (IL-6), serum Interleukin-6 soluble Receptor (IL-6 sR), C-Reactive Protein (C-RP), plasmatic Zinc levels (PlZn) and their response in relation to Zn administered by TPN, in critical patients. Methods: 17 patients, receiving TPN as a consequence of acute pancreatitis (n = 4) or after a major abdominal surgery due to intestinal cancer (n = 7), intestinal fístula (n = 3), intestinal obstruction (n = 2) or intestinal íleus (n = 1) were studied. At the beginning (To) and at the end of the TPN administration (6-21days) serum IL-6 and IL-6 sR were determined by ELISA; C-RP ultrasensitive (C-RP us) by inmunoturbidimetric method; Zn was determined in TPN and in plasma by Atomic Absorption Spectrometry. Characteristics of the patients were (mean ± SD and ranges): age: 60.6 ± 11.7 (37-77) years; BMI (kg/m2): 26.0 ± 3.4 (19.9-34.0). Results: The results (mean ± standard deviation and ranges) were: Zn provided by TPN (mg/d): 6.1 ± 2.0 (range 2.8 to 10.8). Biochemical levels were, at To and Tf, respectively: (mean±SD and ranges) were at To y Tf, respectively: Zn Pl (μg/dl): 104 ± 46 (35-177); 120 ± 55 (52-229); IL-6 (pg/mL) 93 ± 74 (10-262); 117 ± 180 (7-761); IL6sR (pg/mL): 1,012 ± 322 (589-1855); 1,269 ± 451 (631-2195); C-RP us (mg/L): 71 ± 63 (2-196); 65 ± 43 (0-137). There was no correlation between variations of IL6, IL6sR, C-RP, PlZn levels and the daily amount of Zn administered in the TPN mixtures. Two patients presented a bad evolution; they received 4.2 and 5.2 md/d of Zn and showed an increase of IL6 levels, maintained high levels of IL6sR but C-RP levels decreased. Conclusions: the range of 2.8 to 10.8 mg/d of Zn administered in TPN mixtures did not exacerbate the inflammatory response (AU)