Serum Zn levels and Cu/Zn ratios worsen in hemodialysis patients, implying increased cardiovascular risk: a 2-year longitudinal study.

The objective of this study was to analyze serum Zn and Cu concentrations and Cu/Zn ratios in 116 hemodialysis patients (HPs) over a 2-year longitudinal study at four time points (6-month intervals). The relation exerted on these values by 26 biochemical and nutritional indexes, the age and drug consumption of the patients, and the etiology of their disease were also evaluated. A healthy control group (n = 50) was also studied. Mean serum Zn concentrations were lower (p = 0.009) and the Cu/Zn ratios higher (p = 0.009) in HPs than in controls. Serum Cu levels in HP did not differ to those of controls. At all four sampling times, the mean serum Zn levels and Cu/Zn ratios were lower and higher, respectively, in HPs than in the controls. There was a significant reduction in serum Zn levels and an increase in Cu concentrations and Cu/Zn ratios in HPs from the second to the fourth sampling. Serum Zn levels of the HPs diminish with age older than 50 years. Serum Cu levels were significantly higher in patients consuming antihypercalcemic or anti-infarction drugs, whereas serum Cu levels and Cu/Zn ratios were significantly lower in those treated with diuretics. Diminished Zn levels were negatively correlated with low-density lipoprotein (LDL) cholesterol in HPs; however, enhanced Cu/Zn ratios were positively correlated with total cholesterol and LDL cholesterol. Both findings indicate an increased cardiovascular risk. We conclude that this study contributes the first evidence of a correlation between marked dyslipidemia and worsened Cu/Zn ratios in HPs, implying an increased risk of diseases associated with elevated oxidative stress, inflammation, and depressed immune function, such as cardiovascular diseases.

In vitro determination of zinc dialyzability from duplicate hospital meals: influence of other nutrients.

OBJECTIVES: We determined zinc (Zn) dialyzability as an indicator of Zn bioavailability in the in vitro gastrointestinal digests of 108 duplicate meals. The interaction exerted by levels of 51 nutrients and energy on total and dialyzable Zn fractions and on Zn dialyzability was also assessed. METHODS: Total and dialyzable Zn levels were measured by flame atomic absorption spectrometry. The Zn dialyzability is expressed as the percentage of dialyzed Zn in relation to the total Zn content in duplicate meals (dialysis Zn percentages). RESULTS: The mean total and dialyzable Zn fractions and Zn dialyzability were 2.180 +/- 1.806 mg, 0.478 +/- 0.556 mg, and 25.23 +/- 15.05%, respectively. The dialysis Zn levels increased significantly with total Zn content in duplicate meals (P < 0.001, r = 0.690). Total and dialyzable Zn fractions found in breakfasts were significantly lower (P < 0.001). The Zn dialyzability was significantly correlated only with total chromium contents, dialyzable copper (Cu) and manganese (Mn) fractions, and Cu and Mn dialyzabilities (P < 0.05). Zn dialyzabilities decreased significantly with increased daily Zn intakes (P = 0.010, r = 0.423). The total Zn supply by meals was directly and significantly (P < 0.001) correlated with their macronutrient contents (carbohydrates, protein, and fiber). The mean daily Zn intake determined was 6.541 mg. CONCLUSION: Duplicate diets studied are moderately low Zn-bioavailability diets. The protein and derivate amino acids act as formers of soluble complexes with Zn in the gastrointestinal tract. Daily Zn levels supplied by hospital meals are low.