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Zinc Deficiency
See also: Zinc Excess and Zinc Toxicity, and Zinc Supplements.
Zinc is an essential mineral that is important for immune function, wound healing, normal taste and smell, and is needed for DNA synthesis. Zinc also supports normal growth and development during pregnancy, childhood, and adolescence.
- Zinc is a co-factor in DNA and protein synthesis and cell division. It is believed to be important in wound healing.
- The UK recommended ranges are 5.5-9.5 mg/day for males and 4.0-7.0 mg/day for females.1
- The body contains 2 to 3 g of zinc (Zn), found mainly in bones, teeth, hair, skin, liver, muscle, leukocytes, and testes.
- One third of the of zinc found in plasma is attached loosely to albumin, and about two thirds is firmly bound to globulins.
- Absorption of zinc salts from food is approximately 20-40%. Absorption of zinc is higher from fish and meat but lower from whole-grain bread and cereals, where phytate content impairs absorption. Zinc is mainly lost from body in faeces.2
- Meat, liver, peas, beans, eggs, and seafood (especially oysters) are good sources of zinc.
Although a confirmed diagnosis of zinc deficiency is rare, relative zinc deficiency caused by poor diet, malabsorption, or following burns and trauma is probably common.
Risk factors
- Excessive loss of zinc can occur in trauma, burns and protein-losing conditions.
- Liver disease
- Inadequate diet or malabsorption
- Prolonged parenteral nutrition (total parenteral nutrition usually includes trace amounts of zinc).
Presentation will depend on the severity of zinc deficiency. Mild deficiency may cause no obvious symptoms, whereas severe deficiency may cause most or even all of the following features.
- Anorexia, lethargy, diarrhoea
- Growth retardation, delayed sexual maturation, hypogonadism and hypospermia
- Alopecia, dermatitis, paronychia
- Mental retardation, impaired nerve conduction and nerve damage
- Hepatomegaly
- Immune disorders and susceptibility to infections
- Iron deficiency anaemia
- Macular degeneration, night blindness
- Impaired taste and smell
- Impaired wound healing
- Maternal zinc deficiency may cause anencephaly in the fetus.
Diagnosis may be difficult to confirm, particularly with mild levels of deficiency.
- Decreased levels of plasma zinc (less than 10.7 μmol/L). Plasma levels are an unreliable indicator of zinc deficiency because the plasma level may be lowered, e.g. in acute infection and after trauma. Hypoproteinaemia spuriously lowers plasma-zinc concentration
- Reduced alkaline phosphatase and plasma testosterone
- Impaired T-lymphocyte function
- Decreased collagen synthesis (resulting in poor wound healing), and decreased RNA polymerase activity in several tissues.
Management is based on both treatment of any underlying cause and zinc supplementation.
Rare autosomal recessive disorder caused by failure to generate a transport protein that enables zinc to be absorbed in the intestine.6,7
- Symptoms usually begin after an infant is weaned from breast milk.
- Presents with psoriasiform dermatitis (characteristic pustular rash over the mucocutaneous junctions, particularly the mouth, the genital areas and pressure areas), hair loss, paronychia, failure to thrive and severe diarrhoea. Also leads to secondary bacterial and fungal infections.
In older children, failure to thrive, anorexia, alopecia, nail dystrophy, and repeated infections are more common.
Similar clinical manifestations are seen in children or adults with zinc deficiency from any cause. - Oral zinc sulphate supplements: if treated early, most of the symptoms are reversible and usually leave no sequelae. Therapy is lifelong and total compliance is essential.
Document References
- Food Standards Agency; Zinc
- Eastwood M; in Oxford Textbook of Medicine 3rd Ed OUP 2003
- Diaz-Gomez NM, Domenech E, Barroso F, et al; The effect of zinc supplementation on linear growth, body composition, and growth factors in preterm infants.; Pediatrics. 2003 May;111(5 Pt 1):1002-9. [abstract]
- Wilkinson EA, Hawke CI; Oral zinc for arterial and venous leg ulcers.; Cochrane Database Syst Rev. 2000;(2):CD001273. [abstract]
- Wilkinson EA, Hawke CI; Does oral zinc aid the healing of chronic leg ulcers? A systematic literature review.; Arch Dermatol. 1998 Dec;134(12):1556-60. [abstract]
- Online Mandelian Inheritance in Man (OMIM); Acrodermatitis Enteropathica; Online Mandelian Inheritance in Man (OMIM)
- Siva Subramanian KN, Silverman RA; Subramanian KNS, Silverman RA. Acrodermatitis Enteropathica. eMedicine (2006); Emedicine
DocID: 570
Document Version: 21
DocRef: bgp1115
Last Updated: 23 Aug 2007
Review Date: 22 Aug 2009
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