Zinc Deficiency:
Zinc deficiencies are quite common in people living in poor countries. Phytate, a substance found in unleavened bread (pita, matzos, and some crackers) significantly reduces absorption of zinc, increasing the chance of zinc deficiency. However, phytate-induced deficiency of zinc appears to be a significant problem only for people already consuming marginally low amounts of zinc.
Even in developed countries, low-income pregnant women and pregnant teenagers are at risk for marginal zinc deficiencies. Supplementing with 25-30 mg per day improves pregnancy outcome in these groups.12 13 People with liver cirrhosis appear to be commonly deficient in zinc.14 This deficiency may be due to cirrhosis-related zinc malabsorption.15People with Down's syndrome are also commonly deficient in zinc.16 Giving zinc supplements to children with Down's syndrome has been reported to improve impaired immunity17 and thyroid function,18 though optimal intake of zinc for people with Down's syndrome remains unclear. Children with alopecia areata (patchy areas of hair loss) have been reported to be deficient in zinc.19 20
The average diet frequently provides less than the Recommended Dietary Allowance for zinc, particularly in vegetarians. To what extent (if any) these small deficits in zinc intake create clinical problems remains unclear. Nonetheless, a low-potency supplement (15 mg per day) can fill in dietary gaps. Zinc deficiencies are more common in alcoholics and people with sickle cell anemia, mal-absorption problems, and chronic kidney disease.21
The signs and symptoms of zinc deficiency include anorexia, growth retardation, delayed sexual maturation, hypogonadism and hypospermia, alopecia, immune disorders, dermatitis, night blindness, impaired taste (hypogeusia), and impaired wound healing. The first signs of zinc deficiency in marginally nourished children are suboptimal growth, anorexia, and impaired taste. Biochemical signs associated with zinc deficiency include decreased levels of plasma zinc (< 70 µg/dL [< 10.7 µmol/L]), alkaline phosphatase, alcohol dehydrogenase in the retina (which accounts for night blindness), and plasma testosterone as well as impaired T-lymphocyte function, decreased collagen synthesis (resulting in poor wound healing), and decreased RNA polymerase activity in several tissues.
Clinical assessment of mild zinc deficiency is difficult because many of the signs and symptoms are nonspecific. Nonetheless, if a malnourished person has a borderline-low plasma zinc level, is subsisting on a high fiber and phytate diet containing whole-grain bread (which reduces zinc absorption), and has reduced taste sensitivity, an impaired lymphocyte response to mitogens, and reduced gonadal hormone function, then zinc deficiency should be suspected, and treatment with zinc supplements (15 to 25 mg/day) should be tried.
Maternal zinc deficiency may cause anencephaly in the fetus. Secondary deficiency occurs in liver disease, in malabsorption states, and during prolonged parenteral nutrition. Night blindness and mental lethargy may be features.
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