Serpil ERDOĞAN, Bedir AKYOL, HASAN ÖNAL, ZERRİN ÖNAL, Eyüp Sabri KELEŞ

Demir eksikliği anemisinde serum çinko düzeylerinin değerlendirilmesi

Amaç: Sosyoekonomik düzeyin düşüklüğü, yanlış beslenme alışkanlıkları, intestinal parazitozlar ve bazı klinik bozukluklar nedeniyle demir ve çinko eksikliği yaygın olarak görülmektedir. Çalışmanın amacı demir eksikliği olan çocuk-larda çinko eksikliğinin prevalansını saptamaktır. Yöntem: Çalışmada demir eksikliği anemisi tanısı konmuş, yaşları 1-12 yıl arasında değişen 22'si erkek (% 62.8), 13'ü kız (% 37.2) toplam 35 çocuk ile yaşları 1-12 yıl arasında değişen 12'si erkek (% 60), 8'i kız (% '40) toplam 20 sağlıklı çocuk çinko eksikliği açısından incelendi. Serum çinko düzeyi ile Hb, Hct, MCV, ferritin, serum demiri (Fe) ve antropometrik ölçümler arasında korelasyon varlığı değerlendirildi. Tüm çocukların iştah durumları, anne sütü, inek sütü, çay, kırmızı et ve balık tüketimleri sorgulandı. Bulgular: Demir eksikliği anemisi olan grupta serum çinko düzeyleri (63.9$pm$12.8 $mu$g/dL), kontrol grubunun ortalama çinko düzeyinden (89.3$pm$17.4 $mu$g/dL) istatistiksel olarak ileri düzeyde anlamlı bir şekilde düşük bulundu. Bununla birlikte hasta grubunda serum çinko düşüklüğünün prevalansı oldukça yüksekti (% 82.8). Serum çinko düzeyleri ile Hb, Hct, MCV, Fe, ferritin düzeyleri arasında istatistiksel olarak anlamlı bir korelasyon saptanmadı. Sonuç: Demir eksikliği anemisi tanısı konan çocuklarda çinko eksikliği oldukça yüksek prevalansda saptandı (% 82.8). Bu durum, çinko eksikliğini tanımlayacak duyarlı ve basit tanı testleri rutine girene kadar çocukluk çağı gibi yüksek risk grubunda erken dönem suplementasyon programları düşünülmesi gereğini ortaya koymaktadır.

Anahtar Kelimeler:

Çinko, Anemi, demir eksikliği, Çocuk, Yaygınlık, Çocuk beslenme bozuklukları

Evaluation of serum zinc levels in iron deficiency anemia

Aim: Iron and zinc deficiency are widely seen as a result of low socioeconomic status, wrong feeding habits, intestinal parasitic diseases and some other clinical disorders. The aim of this study is to detect the prevalance of zinc deficiency in children with iron deficiency anemia. Methods: Thirty-five children with iron deficiency anemia ages between 1-12 years [22 male (62.8 %), 13 female (37.2 %)] and 20 healthy children, ages between 1-12 years [12 male (60 %), 8 female (40 %)] were included in the study. The correlation between serum zinc level and Hb, Hct, MCV, ferritin, serum iron and antropometric measurements were evaluated. All children were investgated about level of their appetite, ingestion of cow's milk, tea, meat, fish and breastfeeding. Results: We detected statistically significant lower level of zinc (63.9$pm$12.8 $mu$g/dL) in the group of iron deficiency anemia compared with the control (89.3$pm$17.4 $mu$g/dL) (p<0.001). The prevalance of zinc deficiency was significantly higher in iron deficiency group (82.8 %). In our study, no statistically significant correlation was detected between serum zinc and Hb, Hct, MCV, ferritin levels. Conclusion: In children with iron deficiency anemia high prevalance of zinc deficiency was detected (82.8 %). This situation suggests the necessity of developing supplementation programs for high risk groups like childhood until more sensitive and simple laboratory tests to detect zinc deficiency are available in routine clinical use.

Keywords:

Zinc, Anemia, Iron-Deficiency, Child, Prevalence, Child Nutrition Disorders,

___

1. Prasad AS. Zinc in human health and disease. Jassoc Physicians India 1993; 41: 519-21.
2. Andrews NC, Kenneth RB. Disorders of iron metabolism and sideroblastic anemia. In: Nathan DG, Oski SH (eds). Hematology of Infancy and Childhood. Vol 1. Philadelphia: WB Saunders, 1998:423-61.
3. Prasad AS, Miale A Jr, Farid Z, et al. Clinical and experimental zinc metabolism in patients with the syndrome of iron deficiency anemia, hepatosplenomegaly, dwarfism, and hypogo-nadism. J Lab Clin Med 1990; 116: 737-49.
4. Arcasoy A. İnsan sağlığında çinkonun önemi. TÜBİTAK Bilim ve Teknik Dergisi 1996: 12-56.
5. Prasad AS. Zinc deficiency in women, infants and children. J Am Coll Nutr 1996; 15: 113-20.
6. Hastka J, Lasserre JJ, Schwarzbeck A, et al. Central role of zinc protoporphyrin in staging .iron deficiency. Clin Chem 1994; 40: 768-73.
7. Van Wouwe JP, van Zuylen L. Changes of zinc values in children during malignant disease. Biol Trace Elem Res 1991; 30: 197-204.
8. Miller LV, Krebs NF, Hambidge KM. Human zinc metabolism: advances in the modeling of stable isotope data. Adv Exp Med Biol 1998; 445: 253-69.
9. Hambidge KM, Krebs NF, Miller L. Evaluation of zinc metabolism with use of stable-isotope techniques: implications for the assessment of zinc status. Am J Clin Nutr 1998; 68: 410S-3S.
10. Ece A, Uyanık BS, Iscan A, et al. Increased serum copper and decreased serum zinc levels in children with iron deficiency anemia. Biol Trace Elem Res 1997; 59: 31-9.
11. Chen XC, Wang WG, Yan HC, et.al. Studies on iron deficiency anemia, rickets and zinc deficiency and their prevention among Chinese preschool children. Prog Food Nutr Sci 1992; 16: 263-77.
12. İnce E, Kemahlı S, Uysal Z, et al. Mild zinc deficiency in preschool children. The Journal of Trace Elements in Experimental Medicine 1995; 7: 135-141.
13. Donma MM, Donma O, Tas MA. Hair zinc and copper concentrations and zinc: copper ratios in pediatric malignancies and healthy children from southeastern Turkey. Biol Trace Elem Res 1993; 36: 51-63.
14. Miller LV, Hambidge KM, Naake VL, et al. Size of the zinc pools that exchange rapidly with plasma zinc in humans: alternative techniques for measuring and relation to dietary zinc intake. J Nutr 1994; 124:268-76.
15. Kılınç Y, Antmen B, Tanyeli A, et al. The height persantiles, nutritional and socioeconomical status and zinc profiles in primary school children in southern part of Turkey. Second International Zinc Symposium 1998.
16. Aras N.K. "Zinc in Turkish Diet and Their Sources", 2nd International Zinc Symposium (organizing committee member), Ankara, Turkey, October 2-3, 1998
17. Çavdar AO, Arcasoy A, Cin S, Guinus H. Zinc deficiency in geophagia in Turkish children and response to treatment with zinc sulphate. Haematologica 1980; 65: 403-8.
18. Henkin RI, Laws JS, Nelson NR. The role of zinc on the trophic growth factors, nerve growth factor and gustin. In: Hurley LS, Keen LL, Blbnnerdal B, Rucker RB (eds). Trace elements in man and animals: New York and London, 1988: 385-7.
19. Ripa S, Ripa R. Zinc and immune function. Minerva Med 1995; 86:315-8.
20. Sazawal S, Black RE, Jalla S, et al. Zinc supplementation reduces the incidence of acute lower respiratory infections in infants and preschool children: a double-blind, controlled trial. Pediatrics 1998; 102: 1-5.
21. Beck FWr Prasad AS, Kaplan J, et al. Changes in cytokine production and T cell subpopulations in experimentally induced zinc-deficient humans. Am J Physiol, 1997; 272: E1002-7.
22. Faruque AS, Mahalanabis D, Haque SS, et al. Double-blind, randomized, controlled trial of zinc or vitamin A supplementation in young children with acute diarrhoea. Acta Pediatr 1999; 88: 154-60.
23. Roy SK, Tomkins AM, Haider R, et al. Impact of zinc supplementation on subsequent growth and morbidity in Bangladeshi children with acute diarrhoea. Eur J Clin Nutr 1999; 53: 529-34.
24. Mossad SB, Macknin ML, Medendorp SV, et al. Zinc glu-conate lozenges for treating the common cold. A randomized, double-blind, placebo-controlled study. Ann Intern Med 1996; 125:81-8.
25. Allen LH, Rosado JL, Casterline JE, et al. Lack of hemoglobin response to iron supplementation in anemic Mexican preschoolers with multiple micronutrient deficiencies. Am J Clin Nutr 2000; 71: 1485-94.
26. Kolsteren P, Rahman SR, Hilderbrand K, et al. Treatment for iron deficiency anaemia with a combined supplementation of iron, vitamin A and zinc in women of Dinajpur, Bangladesh. Eur J Clin Nutr 1999; 53: 102-6.
27. Abdulla M, Suck C. Blood levels of copper, iron, zinc, and lead in adults in India and Pakistan and the effect of oral zinc supplementation for six weeks. Biol Trace Elem Res 1998; 61: 323-31.
28. Kılıç I, Özalp I, Coşkun T, et al. The effect of zinc supplemented bread consumption on school children with asymptomatic zinc deficiency. J Pediatr Gastroenterol Nutr 1998; 26: 167-71.