Çocuklarda Demir Eksikliği Anemisinde Çinkonun Önemi

ÖzDemir ve çinko, çocuk büyüme ve gelişmesinde önemli rol oynayan elementlerdir. Her iki element de hücre bölünme ve farklılaşmasında, bağışıklık sisteminin düzenlenmesinde, kemik gelişiminde, zekâ ve algılama fonksiyonunda etkilidir. Bu iki eser elementin eksikliğinin aynı anda bulunması belirtileri derinleştirebilmektedir.Demir eksikliği ve/veya Demir eksikliği anemisi saptanan olgularda, demir tedavisine rağmen anemide düzelme olmazsa başta çinko olmak üzere diğer elementlerin eksiklikleri düşünülmelidir. Son zamanlarda demir ve çinko içeren preparatlar da kullanıma girmiştir. Demir/çinko oranının 2:1 olduğu durumda çinkonun demir emilimini etkilemediğini, çalışmalarda çinko ve demirin birlikte verilmesinin süt çocuklarında büyümeyi sağladığını, boyu uzattığını, motor gelişimini ve davranışları düzenlediğini belirtilmektedir.

Anahtar Kelimeler:

Demir eksikliği anemisi, çinko, çocukluk dönemi

The Role of Zinc in The Iron Deficiency Anemia in Childhood

AbstractIron and zinc are essential elements in childhood growth. Both of them play im-portant role in cleavage and cell differentiation, immunomodulation, bone development, development of intelligence and perception. The clinical signs may be comesevere if these both are deficient. The child who had drug resistance iron deficiencyand/or iron deficiency anemia has to be investigated for deficiencies of zinc and other elements. Recently, drugs that include zinc together with iron have been debated in terms of treatment efficacy. In the fact that the Fe:Zn ratio is 2:1, both of theelements will be absorbed well and this will lead to linear growth, motor, mental andbehavioral development.

Keywords:

Iron deficiency anemia, zinc, childhood,

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Kaynaklar 1.Dallman PR. Progress in the prevention of iron deficiency ininfants. Acta Pediatr Scand 1990; 365: 28-37. 2.Gümrük F, Altay Ç. Demir metabolizması ve demir eksikliğianemisi. Katkı Pediatri Dergisi 1995; 16 (3): 265-287. 3.Oski FA. Iron deficiency in infancy and childhood. N Engl JMed 1993; 329 (3): 190-93. 4.World Health Organisation: Preventing and ControllingIron Deficiency Anemia through Primary Health Care. Ge-neva 1989. 5.Conrad ME, Umbreit JN. A concise review: Iron absorption-the mucin-mobilferrin-integrin pathway. A competitive path-way for metal absorption. Am J Haemat 1993; 42: 67. 6.Schneider JM, Fujii ML, Lamp CL, Lönnerdal B, Zidenberg-Cherr S. Anemia, iron deficiency and iron deficiency anemiain 12-36 months old children from low-income families. AmJ Clin Nutr 2005; 82: 1269-75. 7.Mamiro PS, Kolsteren P, Roberfroid D, Tatala S, OpsomerAS, Van Comp JH. Feeding practices and factors contribu-ting to wasting, stunting and iron deficiency anemia among3-23-month old children in Kilosa district, rural Tanzania. JHealth Popul Nutr 2005; 23: 222-30. 8.Siegel EH, Stoltzfus RJ, Khatry SK, Leclerq SC, Katz J, TielschJM. Epidemiology of anemia, among 4-to-17-month-oldchildren living in south central Nepal. Eur J Clin Nutr 2006;60: 228-35. 9.Derman O, Oksüz-Kanbur N, Yenicesu I, Klink E. Iron deficiencyanemia in a group of Turkish adolescents: frequency and contri-buting factors. Int J Adolesc Med Health 2005; 17: 179-86. 10.Kara B, Cal S, Aydoğan A, Sarper N. The prevalence of ane-mia in adolescents: a study from Turkey. J Pediatr HematolOncol 2006; 28: 316-21. 11.World Health Organization. Iron deficiency anemia assess-ment, prevention, and control. A guide for program managers.Geneva (Switzerland): World Health Organization; 2001. 12.Çetin E. İstanbul’da yaşayan çocuk ve adolesanlarda anemiprevalansının araştırılması (Tez). İstanbul: İstanbul Üniver-sitesiTıp Fakültesi; 1997. 13.Evliyaoğlu N, Altıntaş D, Atıcı A. Anne sütü, inek sütü ve for-mula mamalarla beslenenlerde demir durumu. Turkiye Klinik-leri J Pediatr 1996; 5: 249-59. 14.Gür E, Yıldız I, Celkan T. Prevalence of anemia and the riskfactors among school children in İstanbul. J Trop Pediatr 2005;51: 346-50. 15.Özdemir N. Çocuklarda demir eksikliği anemisi Türk Ped Arş2015; 50: 11-19. 16.Kırmızıtaş A. Demir eksikliği anemisi olan çocuklarda çözüne-bilir transferrin reseptörü, eritrosit çinko düzeyi ve serum çin-ko düzeyinin tanıdaki yeri (Tez). Adana: Çukurova Üniversite-si Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı; 2005. 17.Zlotkin S, Arthur P, Antwi KY, Yeung G. Randomized control-led trial of single versus 3-times-daily ferrous sulfate dropsfor treatment anemia. Pediatrics 2001; 108: 613-16. 18.Black RE, Allen LH, Bhutta ZA, et al. Maternal and child un-der nutrition: global and regional exposures and health con-sequences. Lancet 2008; 371: 243–60. 19.Prasad AS. Clinical spectrum of human zinc deficiency. In:Prasad AS, ed. Biochemistry of Zinc. New York: Plenum Press,1993; 219-58. 20.Torbjörn L, Bo L, Hans S, et al. Zinc deficiency. BMJ 2003;326: 409-10. 21.Sreedhar B. Zinc supplementation and its interactions with iron.BMJ 2003; 75:10-12. 22.Wieringa EA. Iron and zinc interactions. Am J Clin Nut 2004;80: 787-88. 23.O’Brien KO, Zavaleta N, Caulfield LE. Prenatal iron supp-lements impair zinc absorption in pregnant Peruvian women.J Nutr 2000; 130: 2251-55. 24.Albayrak Z. Demir eksikliği anemisinde serum çinko düzeyive tedavinin değerlendirilmesi (Tez). İstanbul: Bakırköy Do-ğumevi Kadın ve Çocuk Hastalıkları Eğitim Hastanesi, 2003. 25.De la Cruz-Góngora V, Gaona B, Villalpando S, Shamah-LevyT, Robledo R. Anemia and iron, zinc, copper and magnesiumdeficiency in Mexican adolescents: National Health and Nut-rition Survey 2006. Salud Publica Mex 2012; 54: 135-45. 26.Lönnerdal B. Dietary factors influencing zinc absorption. JNutr 2000; 130: S1378–83. 27.Prasad AS, Miale A Jr, Farid Z, Sandstead HH, Schulert AR.Zinc metabolism in patients with the syndrome of iron defi-ciency anemia, hepatosplenomegaly, dwarfism, and hypogo-nadism. J Lab Clin Med 1963; 61: 537-49. 28.Arcasoy A, Cavdar AO, Babacan E. Decreased iron and zincabsorption in Turkish children with iron deficiency and ge-ophagia. Acta Haematol 1978; 60: 76-84. 29.Çavdar O, Arcasoy A, Cin S, Babacan E, Gözdaşoğlu S. Ge-ophagia in Turkey: iron and zinc deficiency, iron and zinc ab-sorption studies and response to treatment with zinc in geop-hagia cases. Prog Clin Biol Res 1983; 129: 71-97. 30. Erdoğan S, Akyol B, Önal H, Önal Z, Keleş ES. Demir eksik-liği anemisinde serum çinko düzeylerinin değerlendirilmesi.Çocuk Dergisi 2003; 3: 49-55. 31.Solomons NW. Competitive interaction of iron and zinc in thediet: consequences for human nutrition. J Nutr1986; 116:927–35. 32.Sandström B. Micronutrient interactions: effects on absorp-tion and bioavailability. Br J Nutr 2001; 2. 181–85.33.Rossander-Hulten L, Brune M, Sandström B, Lönnerdal B,Hallberg L. Competitive inhibition of iron absorption by man-ganese and zinc in humans. Am J Clin Nutr1991; 54: 152–56. 34.Rosado JL, Lopez P, Munoz E, Martinez H, Allen LH. Zincsupplementation reduced morbidity, but neither zinc nor ironsupplementation affected growth or body composition of Me-xican preschoolers. Am J Clin Nutr 1997; 65: 13–19. 35.Schultink W, Merzenich M, Gross R. Effects of iron-zinc supp-lementation on the iron, zinc and vitamin A status of anemic pre-schoolchildren in Indonesia. Food Nutr Bull 1997; 18: 311-17. 36.Kolsteren P, Rahman SR, Hilderbrand K, Diniz A. Treatmentfor iron deficiency anemia with a combined supplementationof iron vitamin A and zinc in women of Dinajpur, Bangladesh.Eur J Clin Nutr 1999; 53: 102-106. 37.Arcagök B, Özdemir N, Yıldız İ, Celkan T. Çocukluk çağındademir eksikliğinin kan çinko düzeyi ile ilişkisi. Çocuk Sağlı-ğı ve Hastalıkları Dergisi 2013; 56: 63-70. 38.Berger J, Ninh NX, Khan NC, et al. Efficacy of combined ironand zinc supplementation on micronutrient status and growthin Vietnamese infants. Eur J Clin Nutr 2006; 60: 443-54. 39.Fahmida U, Rumawas JS, UtomoB, Patmonodewo S, Schul-tink W. Zinc-iron, but not zinc alone supplementation, increa-sed linear growth of stunted infants with low haemoglobin. AsiaPac J Clin Nutr 2007; 16: 301-309. 40.Black MM, Baqui AH, Zaman K, et al. Iron and zinc supplemen-tation promote motor development and exploratory behavioramong Bangladeshi infants. Am J Clin Nutr 2004; 80: 903-910. 41.Olivares M, Pizarro F, Ruz M. Zinc inhibits nonheme iron bi-oavailability in humans. Biol Trace Elem Res 2007; 117: 7-14.