Could Urinary Copper/Zinc Ratio Be a Newer Tool to Replace 24-Hour Urinary Copper Excretion for Diagnosing Wilson Disease in Children?

Purpose: Although the 24-hours urinary copper excretion is useful for the diagnosis of Wilson disease (WD), there are practical difficulties in the accurate and timed collection of urine samples. The purpose of this study was to verify if the spot morning urinary Copper/ Zinc (Cu/Zn) ratio could be used as a replacement parameter of 24-hours urinary copper excretion in the diagnosis of WD. Methods: A cross-sectional study was conducted at the Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from June 2019 to May 2021 on 67 children over three years of age who presented with liver disease. Twenty-seven children who fulfilled the inclusion criteria for WD were categorized into the test group, and the remaining forty children were considered to have non-Wilsonian liver disease and were categorized into the control group. Along with other laboratory investigations, spot morning urinary samples were estimated for the urinary Cu/Zn ratio in all patients and were compared to the 24-hour urinary copper excretion. The diagnostic value of the Cu/Zn ratio was then analyzed. Results: Correlation of spot morning urinary Cu/Zn ratio with 24-hours urinary copper excretion was found to be significant (r=0.60). The area under ROC curve with 95% confidence interval of morning urinary Cu/Zn ratio measured using 24-hours urine sample was 0.84 (standard error, 0.05; p<0.001). Conclusion: Spot morning urinary Cu/Zn ratio seems to be a promising parameter for the replacement of 24-hours urinary copper excretion in the diagnosis of WD.

Association of Urinary Zinc Concentrations with Dyslipidemia and Its Subtypes: Baseline Data from the Chinese Multi-Ethnic Cohort (CMEC) Study.

This study elucidates the association between urinary zinc concentration and the risk of developing dyslipidemia and its subtypes in China's ethnic minority residents. Based on the baseline survey data of the Chinese Multi-Ethnic Cohort (CMEC) study, 10,620 subjects were included in the study. Logistic regression analysis evaluated the relationship between urinary zinc concentration and dyslipidemia and its subtypes. After adjustment, compared with urinary zinc concentration quartile 1 (Q1), the odds ratios (ORs) and 95% confidence intervals (95% CIs) of dyslipidemia participants in the quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4) groups were 1.091 (0.963, 1.237), 1.151 (1.051, 1.304), and 1.393 (1.230, 1.579), respectively (P for trend < 0.001). While that of hypertriglyceridemia participants in the Q2, Q3, and Q4 groups were 1.130 (0.979, 1.306), 1.283 (1.113, 1.480), and 1.483 (1.287, 1.709), respectively (P for trend < 0.001). Lastly, the ORs and 95% CIs of hyperbetalipoproteinemia participants in the Q2, Q3, and Q4 groups were 1.166 (0.945, 1.439), 1.238 (1.007, 1.522), and 1.381 (1.126, 1.695), respectively (P for trend < 0.002). This study found that urinary zinc concentrations were not associated with hypercholesterolemia and hypoalphalipoproteinemia. The dose-response relationship was non-linear between urinary zinc concentration and dyslipidemia, hypertriglyceridemia and hyperbetalipoproteinemia (P for trend < 0.001). In the stratified analysis, urinary zinc levels were positively associated with the risk of dyslipidemia, hypertriglyceridemia, and hyperbetalipoproteinemia in male, ≥ 60 years old, Miao nationality, hypertension, diabetes, and BMI ≥ 24.0 kg/m2 subgroups. Our study provides some possible evidence that elevated urinary zinc concentrations are associated with an increased risk of dyslipidemia, hypertriglyceridemia, hyperbetalipoproteinemia.

A Study on the Zinc Intake and Urinary Excretion of Preschool Children in Busan

To assess zinc status by dietary intake and urinary excretion of preschool children in Busan and to evaluate the relationship of intakes of food and nutrient with urinary zinc excretion, zinc food frequencies of 40 common foods affecting intakes of zinc by food fequency method, nutrient intake by 24hr recall and 24hr urinary zinc excretion were measured with 97 preschool children. The mean zinc intake was 4.29 mg and 43.0% of RDA. The mean zinc intake per 1,000 kcal was 3.09 mg.97.9% of subjects had zinc intake less than 75% of RDA. Grains food group was the primary source of zinc intake and supplied 38.9% of the total daily zinc intake. Altogether, plant food products supplied 49.7% of zinc intake. The mean urinary zinc excretion and zinc excretion per gram of creatinine were 0.19 mg and 1.00 mg respectively. The urinary zinc excretion showed positive significant correlations with height and weight (p<0.05, p<0.05) , urine volume and urinary creatinine excretion (p<0.05, p<0.001) , urinary zinc excretion per creatinine (p<0.001) , urinary zinc excretion per weight (p<0.001) , intakes of energy and carbohydrate (p<0.05, p<0.01) and usual intake of zinc from eggs food group (p<0.05) . In conclusion, these results show that the zinc intake of preschool children is low and that sources of dietary zinc are mainly plant foods, suggesting low bioavailability. So nutritional education is needed in order to inc-rease usual intake of animal food group. Interpretation of urinary zinc excretion data is complicated by current uncertainty about "normal" zinc level at this age group. Further studies are needed to obtain extensive data on urinary zinc excretion for this age group.age group.

Zine Status of Adult Female in the Taegu Region as Assessed by Dietary Intake and Urinary Excretion / 대한지역사회영양학회지

This study was intended to examine the zinc status of free-living adult women living in the Taegu region. Zine intake of 102 female subjects was measured by food frequency method for 3 consecutive days. Urinary zine was assessed from urine samples collected fir twenty four hours. Average dietary zinc intake of adult female subjects using food record was 5.9+/-1.8 mg which was 49% of Korean RDA. When zine intake by frequency method was higher than by food record. Average urinary zine intake by frequency method was higher than that by food record. Thus, it appeared that zinc intake by frequency method was higher than that by food record. Average urinary zinc excretion of 102 adult female subjects was 0.28+/-0.16 mg, which belonged to marginal zinc deficiency range. Fifty nine of 102 subjects showed marginal zinc deficiency as assessed by urinary zinc excretion. If we compare the zinc status of adult female subjects by age group, zinc intake in the 50s was significantly higher than any other age groups. However, there were no significant differences in zinc status according to BMI groups and BMI groups. Significant correlations were found between zinc intake and energy, protein, carbohydrate and fat intake. Based on dietary zinc intake and urinary zinc, we concluded that zinc status of adult female living in the Taegu region is marginally deficient.