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Zinc presentation (1)

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zinc in health and disease

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Zinc presentation (1)

  1. 1. Dr.Lokesh R pediatrics
  2. 2. INTRODUCTION • Zinc, a divalent cation, Atomic no-30 • Essential micro-nutrient •Role of zinc- Over 300 metalloenzymes and over 2000 transcription for regulation of lipid, protein and nucleic acid metabolism, and gene transcription.
  3. 3. DIETARY SOURCES(mg/100grams) • Oysters - 25 • Meat - 5.2 • Nuts - 3 • Shell fish -2.7 • Poultry -1.5 • Eggs - 1.3 • Milk products - 1.2 • Cereals - 1 • Bread - 1 • Fish -0.8 • Green vegetables -0.4 • Potatoes - 0.3 • Fresh fruits -0.09
  4. 4. METABOLISM OF ZINC
  5. 5. RDA • Infants • 0 - 6 months: 2* (mg/day) • 7 - 12 months: 3* mg/day • *Adequate Intake (AI) • Children • 1 - 3 years: 3 mg/day • 4 - 8 years: 5 mg/day • 9 - 13 years: 8 mg/day • Adolescents and Adults • Males age 14 and over: 11 mg/day • Females age 14 to 18 years: 9 mg/day • Pregnant and lactating mothers: 25mg/day Uptodate.com
  6. 6. PHYSIOLOGICAL FUNCTIONS OF ZINC • Biochemical functions : – Cofactor for enzymes – Activity of zinc finger proteins • Cellular functions : – Growth & cell development – Cell membrane integrity – Tissue growth & repair – Wound healing Immunological functions : function of neutrophils, T cells, B cells and NK cells
  7. 7. PHYSIOLOGICAL FUNCTIONS OF ZINC • Endocrinological functions: o Reproduction: spermatogenesis o Thyroid function o Pancreatic function-Insulin storage and release o Prolactin secretion o Thymopoetin synthesis • Neurological function: Cognition, memory, taste acuity, vision • Hematological function : coagulation factors • Skeletal function : Bone mineralization
  8. 8. ZINC AND IMMUNITY • impaired phagocytic function, lymphocyte depletion, decreased immunoglobulin production, a reduction in the T4+/T8+ ratio, and decreased interleukin (IL)-2 production
  9. 9. ZINC DEFICIENCY • The true prevalence of mild zinc deficiency is not known because of the non-specificity of symptoms and imprecise diagnostic methods • Indirect diagnosis by supplementation of zinc 1- 2 weeks and improvement in symptoms • More common in developing countries
  10. 10. ZINC DEFICIENCY CAUSES  Dietary zinc depletion -low zn diet, binding of zn Phytates, fiber, iron and copper  Malabsorption  Burns  Chronic renal disease  Acrodermatitis enteropathica  Crohn disease  Cystic fibrosis  TPN  Liver disease and alcoholism
  11. 11. ZINC DEFICIENCY CLINICL FEATURES • Mild – Depressed immunity, impaired taste and smell, onset of night blindness, decreased spermatogenesis. • Moderate -growth retardation and delayed puberty in adolescents, hypogonadism in males, rough skin, poor appetite, mental lethargy, delayed wound healing, night blindness • Severe –severe immune suppression, frequent infections, bullous pustular dermatitis, diarrhoea, alopecia
  12. 12. ACRODERMATITIS ENTEROPATHICA • AR inherited partial defect in intestinal zinc absorption. • encodes a protein that appears to be involved in zinc transportation • erythematous and vesiculobullous dermatitis • alopecia, ophthalmic disorders, diarrhea, severe growth retardation, delayed sexual maturation, neuropsychiatric manifestations, and frequent infections. • Replacement doses of 3 mg/kg/day of elemental zinc
  13. 13. ACRODERMATITIS ENTEROPATHICA
  14. 14. DIAGNOSIS • Blood investigations- zinc in plasma,(spectrophotometric) erythrocytes, neutrophils, lymphocytes, and hair • < 60 mcg/dL • Hypoalbuminemia - decreased levels • Zinc levels in neutrophils or lymphocytes may be more sensitive • Zinc levels in lymphocytes (<50 mcg/1010 cells) or granulocytes (<42 mcg/1010 cells) • Depressed serum alkaline phosphatase levels
  15. 15. Treatment Dose (elemental zinc) • Infants and children-0.5 to 1 mg/kg/day 1-3 divided doses • 1-2mg/kg impaired absorption, diarrhoea,burns • 3 mg/kg/day acrodermatitis enteropathica / wilson’ s disease. • Diarrhea treatment malnourished (WHO/UNICEF 2004) • < 6 months 10mg/day for 10-14 days • > 6months 20mg/day for 10-14 days
  16. 16. Zinc in acute diarrhea • Reduces duration of diahheal episode by 25% • Decrease by about 25% the proportion of episodes lasting more than seven days • It is associated with a 30% reduction in stool volume • Conclusion: significant beneficial impact on the clinical course of acute diarrhea: reduces both severity and duration, also decrease in diarrheal episodes 2-3 months WHO/UNICEF Joint statement: Clinical management of acute diarrhea. WHO/FCH/CAH/04.7. Geneva, 2004.
  17. 17. aZinc in persistent diarrhoea • Zinc-supplemented children had: – 24% lower probability of continuing diarrhoea – 42% lower rate of treatment failure or death • Conclusion: zinc supplementation reduces the duration and severity of persistent diarrhoea UNICEF/TACRO, Health and Nutrition/Immunization Plus
  18. 18. Zinc in bloody diarrhoea • Positive impact of the prevalence of dysentery in the month following the supplementation • Improves seroconversion to shigellaciddal antibody response and increases the proportions of circulating B lymphocytes and plasma cells and the IgA-specific immunoglobulin response Conclusion: zinc supplementation should be given as an adjunct to antibiotic treatment of bloody diarrhoea UNICEF/TACRO, Health and Nutrition/Immunization Plus
  19. 19. Adverse Reactions • Central nervous system: Dizziness, headache • Gastrointestinal: Abdominal cramps, diarrhea, nausea, vomiting
  20. 20. ZINC TOXICITY • Doses up to 10 times tolerated Acute poisoning 1 to 2 g zinc sulphate CF -nausea and vomiting associated with irritation and corrosion GI tract, acute renal failure ,tubular necrosis or interstitial nephritis Symptomatic treatment chronic intake > 100 mg per day may be associated with copper deficiency Treatment; EDTA
  21. 21. Cochrane acute respiratory group zinc and common cold • 18 JUN 2013 • Zinc <24 hrs, onset of symptoms reduces the duration of common cold symptoms in healthy people • zinc lozenges formulation widely studied, significant reduction in the duration of cold at a dose of ≥ 75 mg/day • currently no firm recommendation can be made because of insufficient data. • When using zinc lozenges (not as syrup or tablets) the likely benefit has to be balanced against side effects, notably a bad taste and nausea.
  22. 22. Zinc supplements for treating thalassaemia and sickle cell disease 20 June 2013. Aim-effect of zinc supplementation in the treatment of thalassaemia and sickle cell disease In Thalassaema Height velocity – increased. No change in Hb, Conclusion- no evidence from RCT- any benefit of zinc, Sickle anemia • total number of clinical infections ,who received zinc 1 year • number of sickle cell crises who received 3 months and 1 year • Hb% level and anthropometry measurements were not significantly different, • Conclusion- mixed evidence , more trials needed
  23. 23. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months, 26 January 2010. • To evaluate the effectiveness of zinc supplementation in the prevention of pneumonia in children aged 2 m to 59 m • 6 trials and 7850 participants in the meta-analysis • The studies were conducted in Bangladesh, India, Peru, and South Africa • Conclusion- significantly associated with reducing the incidence and prevalence of pneumonia among children of 2 to 59 months of age. Evidence provided so far from randomized controlled trials is sufficient to recommend zinc intake in deficient populations through supplementation, dietary improvements, or fortification, for enhancing child survival.
  24. 24. Oral zinc for treating diarrhoea in children 31 Jan 2013• To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea. • 24 trials, 9128 children • shorten the duration of diarrhoea by around 10 hours • In children with signs of moderate malnutrition the effect appears greater, reducing the duration of diarrhoea by around 27 hours • < 6 months infants no effect on mean diarrhoea duration • No trials reported serious adverse events, but vomiting in both age group Persistent diarrhoea • Shortens by 16 hours conclusions • In areas with zinc deficiency or the prevalence of moderate malnutrition is high, zinc may be of benefit in children >6m • current evidence does not support the use of zinc supplementation in children <6m infants
  25. 25. Commonly used brands
  26. 26. REFERENCES • Nutrition and child development KE Elizabeth 4th edition • www.uptodate.com • Clinical biochemistry, Allan gaw 5th edition • http://www.zinc.rg/info/zinc_essential_for_human_health • WHO/UNICEF Joint statement: Clinical management of acute diarrhea. WHO/FCH/CAH/04.7. Geneva, 2004.
  27. 27. Thank you

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