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Low Zinc Levels Seen With Liver Cirrhosis, Hepatic Encephalopathy

Serum zinc is often deficient in patients with liver cirrhosis and hepatic encephalopathy (HE), according to a study published online in the September issue of the Journal of Family Medicine and Primary Care.

Divakar Kumar, M.D., from the Rajendra Institute of Medical Sciences Ranchi in India, and colleagues measured the serum zinc level in 150 patients with liver cirrhosis with HE.

The researchers found that the majority of patients with liver cirrhosis with HE had zinc deficiency. There was a statistically significant association between low serum zinc levels and West Haven criteria grades of HE. Across classes of cirrhosis, serum zinc levels showed highly significant differences. In patients who died, the mean serum zinc level was significantly low (35.56 versus 48.36). There was a strong positive correlation between serum zinc and serum albumin levels (r = 0.88).

"All patients with liver cirrhosis with HE and hypoalbuminemia should be evaluated for zinc deficiency. Hypozincemia is significantly associated with mortality in HE so it can also be used as a prognostic marker," the authors write. "Early screening for serum zinc level in patients with liver cirrhosis with HE and its replacement could result in prevention of worsening of HE and can also be used in treatment of HE, which can be proved by larger study particularly a case control study or randomized control trial."

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Metal Exposure Tied to Atherosclerosis Progression

Metal exposure from environmental pollution is associated with the progression of atherosclerosis, according to a study published online Sept. 18 in the Journal of the American College of Cardiology.

Katlyn E. McGraw, Ph.D., from the Columbia University Mailman School of Public Health in New York City, and colleagues examined whether exposure to metals from environmental pollution is related to atherosclerosis progression. The analysis included data from 6,418 participants in the Multi-Ethnic Study of Atherosclerosis.

The researchers found that for the highest to lowest quartile of urinary cadmium, coronary artery calcium (CAC) levels were 51 percent higher at baseline and 75 percent higher during the 10-year period. Corresponding CAC levels during the 10-year period were 45 percent higher for urinary tungsten, 39 percent higher for uranium, and 47 percent higher for cobalt, with no difference for models with and without adjustment for clinical factors. When adjusting for clinical factors, the corresponding estimates dropped for copper and zinc from 55 to 33 percent and from 85 to 57 percent, respectively. The associations of metals with CAC were similar in magnitude to classical cardiovascular disease risk factors.

"Our findings highlight the importance of considering metal exposure as a significant risk factor for atherosclerosis and cardiovascular disease," McGraw said in a statement. "This could lead to new prevention and treatment strategies that target metal exposure."

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FDA to Investigate Safety of Toxic Metals in Tampons

The U.S. Food and Drug Administration announced Tuesday that it will launch an independent review into any possible effects of toxic metals found in tampons.

The announcement follows the release of a study in July that found traces of lead and other metals in 30 tampons from 14 brands obtained from major online retailers and stores in the United States, the U.K. and Greece. That study was conducted by a team at the University of California, Berkeley, and published in the journal Environmental International.

"The FDA is aware of concerns about tampon safety after a 2024 study found metals in tampons during laboratory testing," the agency said in its announcement.

The agency stressed that tampons are tested for safety and effectiveness before making it to store shelves, but added that its review of existing data and its own laboratory study should clear up questions raised by the UC Berkeley study.

"While the study found metals in some tampons, the study did not test whether metals are released from tampons when used," the FDA noted. "It also did not test for metals being released, absorbed into the vaginal lining, and getting into the bloodstream during tampon use."

"The FDA’s laboratory study will measure the amount of metals that come out of tampons under conditions that more closely mimic normal use," the agency added. "These initiatives will enable the FDA to complete a risk assessment of metals contained in tampons, based on a worst-case scenario of metal exposure."

No timeline has been given for the completion of the study and publication of results.

The UC Berkeley study was led by Jenni Shearston, a postdoctoral scholar at the university's School of Public Health. Her team looked for concentrations of arsenic, barium, calcium, cadmium, cobalt, chromium, copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium and zinc in commercially available tampons.

Various metals were found in the products, and in one product all 16 metals were detected, the team said.

Organic tampons had less lead and more arsenic than non-organic ones. The study also found that products sold in the United States had higher concentrations of lead than those marketed in Europe.

"Our findings point towards the need for regulations requiring the testing of metals in tampons by manufacturers," the researchers wrote.

Tampons are made with cotton, rayon or a combination of the two. Researchers said the metals could have came from the soil through the plants used to make the products. The presence of metals could also be linked to chemicals used in the tampons as antimicrobials or to control odor.

The July study spurred the Democratic Women’s Caucus to send a letter on Sept. 5 that asked the FDA to examine the issue.

“Women use about 7,400 tampons over the course of their reproductive years, so the presence of potentially harmful metals and chemicals in these products is incredibly concerning,” caucus members wrote. “We urge the FDA to take swift action to ensure that women are safe from harmful and toxic substances in tampons.”

More information

The World Health Organization has more on lead poisoning.

SOURCE: U.S. Food and Drug Administration, news release, Sept. 10, 2024; Democratic Women's Caucus, letter, Sept. 5, 2024; Environmental International, July 3, 2024

Global Study Reveals Widespread Micronutrient Deficiencies

More than 5 billion people globally do not consume enough iodine, vitamin E, and calcium, according to a study published online Aug. 29 in The Lancet Global Health.

Simone Passarelli, Ph.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues estimated micronutrient intake using a novel approach accounting for the shape of a population's nutrient intake distribution, based on dietary intake data from 31 countries. These distributions were applied to data for 185 countries for 34 age-sex groups to estimate the prevalence of nutrient intakes for 99.3 percent of the global population.

The researchers found that more than 5 billion people do not consume enough iodine, vitamin E, and calcium (68, 67, and 66 percent of the global population, respectively). More than 4 billion people do not consume enough iron, riboflavin, folate, and vitamin C (65, 55, 54, and 53 percent, respectively). Within the same country and age groups, estimated inadequate intakes were higher for women with regards to iodine, vitamin B12, iron, and selenium, and for men with regards to magnesium, vitamin B6, zinc, vitamin C, vitamin A, thiamin, and niacin.

"We hope this analysis sheds light on crucial nutrition challenges for locations without the necessary means to collect primary data, and improves understanding of global micronutrient inadequacy so that public health interventions can more effectively address deficiencies," the authors write.

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Editorial

Elevated Metals in Plasma, Urine Linked to ALS Risk, Survival

Elevated metal levels in plasma and urine are associated with amyotrophic lateral sclerosis (ALS) risk and survival, according to a study published online Aug. 6 in the Journal of Neurology, Neurosurgery & Psychiatry.

Dae-Gyu Jang, Ph.D., from the University of Michigan in Ann Arbor, and colleagues examined associations of metal measures in plasma and urine with ALS risk and survival. The association between exposure mixtures and ALS risk and survival and exposure source was examined using environmental risk scores (ERS). ALS- and metal-polygenic risk scores (PGS) were also constructed.

Plasma and urine samples were included for 454 ALS patients and 294 controls. The researchers observed significant associations for elevated levels of individuals metals, including copper, selenium, and zinc, with ALS risk and survival. ERS representing metal mixtures was strongly associated with ALS risk (odds ratios, 2.95 and 3.10 for plasma and urine, respectively) and with poorer ALS survival (hazard ratios, 1.37 and 1.44 for plasma and urine, respectively). The significance of the association of metals with ALS risk and survival was not altered by the addition of ALS-PGS or metal-PGS. Elevated ERS was seen in association with occupations with high potential metal exposure. Occupational and nonoccupational exposures to metals were associated with measured plasma and urine metal levels.

"We demonstrate that metal mixtures, as represented by cumulative ERS, associate with increased ALS risk and reduced ALS survival, regardless of genetic predisposition. These associations correlate with self-reported occupational metal exposure," the authors write. "Overall, these results offer valuable insights into the complexities of ALS pathogenesis."

Two authors are listed as inventors on a patent titled "Methods for Treating Amyotrophic Lateral Sclerosis" that targets immune pathways for use in ALS therapeutics; one author disclosed ties to Evidera.

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Urinary Metal Levels Linked to Increased Risk for CVD, Mortality

Urinary metal levels are associated with an increased risk for cardiovascular disease (CVD) and all-cause mortality, according to a study published online Aug. 1 in Circulation.

Irene Martinez-Morata, M.D., Ph.D., from the Columbia University Mailman School of Public Health in New York City, and colleagues examined the prospective association of urinary metals with incident CVD and all-cause mortality in the racially diverse Multi-Ethnic Study of Atherosclerosis. Data were included for 6,599 participants with urinary metals available at baseline (2000 to 2001) who were followed through December 2019.

The researchers found that 1,162 participants developed CVD and 1,844 participants died during follow-up. Comparing the highest with the lowest quartiles, the hazard ratios for incident CVD and all-cause mortality were 1.25 and 1.68 for cadmium; 1.20 and 1.16 for tungsten; 1.32 and 1.32 for uranium; 1.24 and 1.37 for cobalt; 1.42 and 1.50 for copper; and 1.21 and 1.38 for zinc, respectively, in models adjusted by behavioral and clinical indicators. For cadmium and copper, a positive linear dose-response was seen with both end points. The adjusted hazard ratios for an interquartile range increase in the mixture of these urinary metals and 10-year survival probability difference for incident CVD and all-cause mortality were 1.29 and −1.1 percent and 1.66 and −2.0 percent, respectively.

"These findings support the role of metals as emerging and preventable risk factors for CVD and all-cause mortality and can inform the development of novel preventive strategies to improve cardiovascular health by mitigating the adverse effects of metals," the authors write.

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Micronutrient Supplementation Slows Geographic Atrophy Progression

Oral micronutrient supplementation slows geographic atrophy (GA) progression in age-related macular degeneration (AMD), according to a study published online July 16 in Ophthalmology.

Tiarnan D.L. Keenan, B.M., B.Ch., Ph.D., from the National Institutes of Health in Bethesda, Maryland, and colleagues examined whether oral supplements slow GA progression in AMD in a post-hoc analysis of the Age-Related Eye Diseases Study (AREDS) and AREDS2 multicenter, randomized trials. A total of 392 eyes from 318 participants with GA were included in AREDS, and 1,210 eyes from 891 participants with GA were included in AREDS2. AREDS participants were randomly allocated to oral antioxidants; zinc (80 mg); combination; or placebo. AREDS2 participants were randomly assigned to lutein/zeaxanthin; docosahexaenoic acid/eicosapentaenoic acid; combination; or placebo. AREDS2 participants were also randomly assigned to alternative AREDS formulations: original, no β-carotene, zinc (25 mg), or both.

The researchers found that proximity-based progression toward the central macula was significantly slower in AREDS eyes with noncentral GA with randomization to antioxidants versus none (50.7 versus 72.9 µm/year). In AREDS2 eyes with noncentral GA, proximity-based progression was significantly slower with randomization to lutein/zeaxanthin versus none among those assigned to AREDS antioxidants without β-carotene (80.1 versus 114.4 µm/year). Area-based progression was not significantly different with randomization to antioxidants versus none in AREDS2 eyes with any GA.

"We've known for a long time that AREDS2 supplements help slow the progression from intermediate to late AMD. Our analysis shows that taking AREDS2 supplements can also slow disease progression in people with late dry AMD," Keenan said in a statement. "These findings support the continued use of AREDS2 supplements by people with late dry AMD."

Several authors disclosed ties to the pharmaceutical industry.

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Calcium, Zinc Intake Tied to Lower Risk for Hypertensive Disorders of Pregnancy

People with higher intakes of calcium and zinc before pregnancy appear to have a significantly lower risk for hypertensive disorders of pregnancy (HDP), according to research presented during NUTRITION 2024, the annual meeting of the American Society for Nutrition, held from June 29 to July 2 in Chicago.

Liping Lu, M.D., Ph.D., from Ball State University in Muncie, Indiana, and colleagues used data from 7,737 pregnant women without chronic hypertension participating in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be to assess the association between preconceptional calcium intake (three months before pregnancy) and odds of HDP. There was a modest inverse association between energy density-adjusted calcium intake and HDP when adjusting for sociodemographic, lifestyle, clinical, and other dietary factors. The odds of HDP were 21 percent lower for participants in the highest quintile of calcium intake versus those in the lowest quintile.

In a second analysis using the same dataset, the researchers examined the association of preconception maternal zinc intake and the risk for HDP. Similarly, when adjusting for age, race, marital status, body mass index, insurance, education, sex of the baby, conception season, poverty, smoking, prenatal vitamin use, and other dietary variables, zinc intake was inversely associated with HDP, with those in the highest quartile for preconception zinc intake being 38 percent less likely to experience HDP than those in the lowest quartile.

"The health of women during the preconception period is strongly linked to the pregnancy outcome," Lu said in a statement. "Adequate nutrient or mineral stores in the body prior to conception can ensure optimal nutrient status for conception and support the early stages of fetal growth and development."

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Tampons May Be a Source of Metal Exposure

Tampon use is a potential source of metal exposure, according to a study published in the August issue of Environmental International.

Jenni A. Shearston, Ph.D., from the School of Public Health at the University of California Berkeley, and colleagues compared the concentrations of 16 metal(loid)s (arsenic, barium, calcium, cadmium, cobalt, chromium, copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium, and zinc) in 30 tampons from 14 tampon brands and 18 product lines.

The researchers found measurable concentrations of all 16 assessed metals, including detectable concentrations of several toxic metals, with elevated mean concentrations of lead (geometric mean [GM], 120 ng/g), cadmium (GM, 6.74 ng/g), and arsenic (GM, 2.56 ng/g). There were differences seen in metal concentrations by region of tampon purchase (United States versus European Union/United Kingdom), by organic versus nonorganic material, and for store- versus name-brand tampons. For example, lead concentrations were higher in nonorganic tampons, while arsenic was higher in organic tampons. Consistently lower concentrations of metals were not seen for any single category.

"Future research is needed to replicate our findings and determine whether metals can leach out of tampons and cross the vaginal epithelium into systemic circulation," the authors write.

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