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Reply to Verma et al. Comment on “Chao, H.-C. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients 2023, 15, 4093”
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Reply published on 30 December 2023, see Nutrients 2024, 16(1), 136.
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Comment

Comment on Chao, H.-C. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients 2023, 15, 4093

1
Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON L8S4K1, Canada
2
Digestive Diseases Clinic, Hamilton Health Sciences, Hamilton, ON L8S4K1, Canada
*
Author to whom correspondence should be addressed.
Nutrients 2024, 16(1), 134; https://doi.org/10.3390/nu16010134
Submission received: 10 November 2023 / Accepted: 27 December 2023 / Published: 30 December 2023
(This article belongs to the Special Issue Nutrition, Physical Activity and Chronic Disease)
We appreciate the recent review article by Chao H.-C. [1]: “Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases.” The author has highlighted an important topic as zinc deficiency (ZD) affects up to 64% of untreated [2,3,4] and up to 40% of CeD patients already following a strict gluten-free diet (GFD) [4].
The review focused on the pediatric population, reporting that untreated pediatric CeD patients exhibit significantly reduced serum zinc levels which subsequently returned to normal upon adopting a GFD [5,6]. Zinc deficiency is also highly prevalent in adult CeD patients before diagnosis and may persist despite a GFD [2,3,7]. Furthermore, patients without CeD who adopt a GFD have a similarly increased risk of ZD, suggesting that this may be related to dietary composition rather than malabsorption [7]. Zinc is the second most abundant micronutrient in the human body [8]. It is well-known that ZD impacts health negatively, leading to delayed sexual development in adolescents, increased risk of infections and decreased wound healing, with other complications including diarrhea and neurological changes such as cerebellar ataxia and dementia [9,10]. The main strategies for combating ZD include dietary modification and supplementation [9]. A specific diet may be a sustainable option to treat micronutrient deficiencies [9]; however, as mentioned [1], there are no clear guidelines on how to provide dietary zinc supplementation, and research on the effect of a zinc-rich diet is lacking. Oral supplements are the first choice to treat ZD; however, they have been associated with adverse events including digestive issues which impact treatment compliance.
Therefore, there is a strong need for studies to evaluate the most effective and best-tolerated zinc supplementation not only in pediatric patients but also in adult CeD patients. Since dietary zinc intake may vary depending on dietary pattern, studies from different countries are needed to identify zinc status and the most appropriate treatment in populations adopting different diets. Collaboration is needed to raise awareness of ZD in CeD as restoring zinc levels will likely result in decreased complications and improvement in overall health in populations adopting a GFD.

Author Contributions

Conceptualization, M.I.P.-S. and A.K.V.; methodology, S.T. and A.K.V.; investigation, S.T.; resources, M.I.P.-S.; data curation, S.T., J.-J.B. and A.K.V.; writing—original draft preparation, A.K.V. and S.T.; writing—review and editing, M.I.P.-S., J.-J.B. and D.A.; visualization, J.-J.B.; supervision, M.I.P.-S. and D.A.; project administration, M.I.P.-S.; funding acquisition, M.I.P.-S. All authors have read and agreed to the published version of the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Chao, H.-C. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients 2023, 15, 4093. [Google Scholar] [CrossRef]
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  6. Rea, F.; Polito, C.; Marotta, A.; Di Toro, A.; Iovene, A.; Collini, R.; Rea, L.; Sessa, G. Restoration of Body Composition in Celiac Children after One Year of Gluten-Free Diet. J. Pediatr. Gastroenterol. Nutr. 1996, 23, 408–412. [Google Scholar] [CrossRef]
  7. Jivraj, A.; Hutchinson, J.M.; Ching, E.; Marwaha, A.; Verdu, E.F.; Armstrong, D.; Pinto-Sanchez, M.I. Micronutrient Deficiencies Are Frequent in Adult Patients with and without Celiac Disease on a Gluten-Free Diet, Regardless of Duration and Adherence to the Diet. Nutrition 2022, 103–104, 111809. [Google Scholar] [CrossRef] [PubMed]
  8. Wessells, K.R.; King, J.C.; Brown, K.H. Development of a Plasma Zinc Concentration Cutoff to Identify Individuals with Severe Zinc Deficiency Based on Results from Adults Undergoing Experimental Severe Dietary Zinc Restriction and Individuals with Acrodermatitis Enteropathica. J. Nutr. 2014, 144, 1204–1210. [Google Scholar] [CrossRef] [PubMed]
  9. Roohani, N.; Hurrell, R.; Kelishadi, R.; Schulin, R. Zinc and Its Importance for Human Health: An Integrative Review. J. Res. Med. Sci. 2013, 18, 144–157. [Google Scholar] [PubMed]
  10. Frederickson, C.J.; Koh, J.-Y.; Bush, A.I. The Neurobiology of Zinc in Health and Disease. Nat. Rev. Neurosci. 2005, 6, 449–462. [Google Scholar] [CrossRef] [PubMed]
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MDPI and ACS Style

Verma, A.K.; Tandon, S.; Blom, J.-J.; Armstrong, D.; Pinto-Sanchez, M.I. Comment on Chao, H.-C. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients 2023, 15, 4093. Nutrients 2024, 16, 134. https://doi.org/10.3390/nu16010134

AMA Style

Verma AK, Tandon S, Blom J-J, Armstrong D, Pinto-Sanchez MI. Comment on Chao, H.-C. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients 2023, 15, 4093. Nutrients. 2024; 16(1):134. https://doi.org/10.3390/nu16010134

Chicago/Turabian Style

Verma, Anil K., Shilpa Tandon, Jedid-Jah Blom, David Armstrong, and Maria Ines Pinto-Sanchez. 2024. "Comment on Chao, H.-C. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients 2023, 15, 4093" Nutrients 16, no. 1: 134. https://doi.org/10.3390/nu16010134

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