Zinc deficiency

Zinc
Symptoms| Diarrhea, hair loss, sexual dysfunction, night blindness, skin rash, increased risk of infections, weight loss, poor healing, abnormal taste, mental slowness[1][2]
Complications| Poor growth[2]
Causes| Low dietary intake, poor absorption, increased loss, increased use[1]
Risk factors| Inflammatory bowel disease, short bowel syndrome, liver or kidney problems, vegetarians, alcoholism, other long term diseases[1]
Diagnostic method| Based on symptoms and risk factors[1]
Treatment| Zinc supplementation[2]
Frequency| 2 billion people[3]

Zinc deficiency is a mineral deficiency due to not enough zinc to meet the bodies needs.[4] Symptoms may include diarrhea, hair loss, sexual dysfunction, night blindness, skin rash, increased risk of infections, weight loss, poor healing, abnormal taste, and mental slowness.[1][2] In children it may result in poor growth.[2] During pregnancy it may result in birth defects or low birth weight.[2]

The most common cause is reduced dietary intake.[5] Other causes may include poor absorption, increased loss, or increased use.[1] Risk factors may include inflammatory bowel disease, short bowel syndrome, liver or kidney problems, vegetarians, alcoholism, and other long term diseases.[1] It may also occur as a result of a genetic condition known as acrodermatitis enteropathica.[3] Diagnosis is often based on symptoms and risk factors as blood zinc levels are not that accurate.[1]

Dietary sounds include meat, beans, and nuts.[5] The Recommended Dietary Allowance (RDA) in the USA is 8 mg/day for women and 11 mg/day for men.[1] Treatment is by zinc supplementation at a dose of 1 to 3 mg/kg elemental zinc per day.[2] Improvement generally occurs within days to weeks.[5]

Zinc deficiency affect about 2 billion people worldwide.[3] It most commonly affects children in the developing world, and old people in the developed world.[3][6] It is uncommon in North America.[1] It is estimated to be involved in nearly half a million deaths in children under 5 a year.[3]

## Contents

* 1 Signs and symptoms
* 1.1 Skin, nails and hair
* 1.2 Gastrointestinal
* 1.3 Vision, smell and taste
* 1.4 Immune system
* 1.5 Cognitive function
* 1.6 Psychological disorders
* 1.7 Growth
* 1.8 Pregnancy
* 1.9 Testosterone
* 2 Causes
* 2.1 Diet
* 2.2 Absorption
* 2.3 Increased loss
* 2.4 Chronic disease
* 3 Mechanism
* 4 Diagnosis
* 4.1 Classification
* 5 Prevention
* 6 Epidemiology
* 7 History
* 8 Farming
* 8.1 Biofortification
* 9 References
* 10 External links

## Signs and symptoms[edit | edit source]

### Skin, nails and hair[edit | edit source]

Zinc deficiency may manifest as acne,[7] eczema, xerosis (dry, scaling skin), seborrheic dermatitis,[8] or hair loss.[8][9] It may also impair or possibly prevent wound healing.[9]

* Acrodermatitis enteropathica

* Acrodermatitis enteropathica

* Acrodermatitis enteropathica

### Gastrointestinal[edit | edit source]

Zinc deficiency can manifest as non-specific oral ulceration, stomatitis, or white tongue coating.[8] Rarely it can cause angular cheilitis (sores at the corners of the mouth).[10]

Zinc deficiency contributes to an increased incidence and severity of diarrhea.[11][12]

Zinc deficiency may lead to loss of appetite.[13] The use of zinc in the treatment of anorexia has been advocated since 1979 by Bakan. At least 15 clinical trials have shown that zinc improved weight gain in anorexia. A 1994 trial showed that zinc doubled the rate of body mass increase in the treatment of anorexia nervosa. Deficiency of other nutrients such as tyrosine, tryptophan and thiamine could contribute to this phenomenon of "malnutrition-induced malnutrition".[14]

### Vision, smell and taste[edit | edit source]

Severe zinc deficiency may disturb the sense of smell[9] and taste.[15][16][17][18][19][20] Night blindness may also be a feature,[9] although most reports of abnormal dark adaptation have occurred in combination with other nutritional deficiencies (e.g. vitamin A).[21]

### Immune system[edit | edit source]

Impaired immune function in people with zinc deficiency can lead to the development of respiratory, gastrointestinal, or other infections, e.g., pneumonia.[9][11][12] The levels of inflammatory cytokines (e.g., IL-1β, IL-2, IL-6, and TNF-α) in blood plasma are affected by zinc deficiency and zinc supplementation produces a dose-dependent response in the level of these cytokines.[22] During inflammation, there is an increased cellular demand for zinc and impaired zinc homeostasis from zinc deficiency is associated with chronic inflammation.[22]

### Cognitive function[edit | edit source]

Cognitive functions, such as learning and hedonic tone, are impaired with zinc deficiency.[23][24] Moderate and more severe zinc deficiencies are associated with behavioral abnormalities, such as irritability, lethargy, and depression (e.g., involving anhedonia).[25] Zinc supplementation produces a rapid and dramatic improvement in hedonic tone (i.e., general level of happiness or pleasure) under these circumstances.[25] Zinc supplementation has been reported to improve symptoms of ADHD and depression.[23][26][27]

### Psychological disorders[edit | edit source]

Low plasma zinc levels have been alleged to be associated with many psychological disorders. Schizophrenia has been linked to decreased brain zinc levels.[28] Evidence suggests that zinc deficiency could play a role in depression.[28][29][30] Zinc supplementation may be an effective treatment in major depression.[31][32]

### Growth[edit | edit source]

Zinc deficiency in children can cause delayed growth[8] and has been claimed to be the cause of stunted growth in one third of the world's population.[33]

### Pregnancy[edit | edit source]

Zinc deficiency during pregnancy can negatively affect both the mother and fetus. Animal studies indicate that maternal zinc deficiency can upset both the sequencing and efficiency of the birth process. An increased incidence of difficult and prolonged labor, hemorrhage, uterine dystocia and placental abruption has been documented in zinc deficient animals.[34] These effects may be mediated by the defective functioning of estrogen via the estrogen receptor, which contains a zinc finger protein.[34] A review of pregnancy outcomes in women with acrodermatitis enteropathica, reported that out of every seven pregnancies, there was one abortion and two malfunctions, suggesting the human fetus is also susceptible to the teratogenic effects of severe zinc deficiency. However, a review on zinc supplementation trials during pregnancy did not report a significant effect of zinc supplementation on neonatal survival.[34]

Zinc deficiency can interfere with many metabolic processes when it occurs during infancy and childhood, a time of rapid growth and development when nutritional needs are high.[35] Low maternal zinc status has been associated with less attention during the neonatal period and worse motor functioning.[36] In some studies, supplementation has been associated with motor development in very low birth weight infants and more vigorous and functional activity in infants and toddlers.[36]

### Testosterone[edit | edit source]

Zinc is required to produce testosterone. Thus, zinc deficiency can lead to reduced circulating testosterone, which could lead to sexual immaturity (Ananda Parsad, et al.) hypogonadism, and delayed puberty.[8]

## Causes[edit | edit source]

### Diet[edit | edit source]

Zinc deficiency can be caused by a diet high in phytate-containing whole grains, foods grown in zinc deficient soil, or processed foods containing little or no zinc.[37][38] Conservative estimates suggest that 25% of the world's population is at risk of zinc deficiency.[39]

In the U.S., the Recommended Dietary Allowance (RDA) is 8 mg/day for women and 11 mg/day for men. RDA for pregnancy is 11 mg/day. RDA for lactation is 12 mg/day. For infants up to 12 months the RDA is 3 mg/day. For children ages 1–13 years the RDA increases with age from 3 to 8 mg/day.[40] The following table summarizes most of the foods with significant quantities of zinc, listed in order of quantity per serving, unfortified.[41] Note that all of the top 10 entries are meat, beans, or nuts.

Food  | mg in a serving  | Percent of 11 mg recommended daily intake

|
|

Oysters, cooked, breaded and fried, 3 ounces (85g) (about 5 average sized oysters)  | 74.0  | 673%
Beef chuck roast, braised, 3 ounces (85g)  | 7.0  | 64%
Crab, Alaska king, cooked, 3 ounces (85g)  | 6.5  | 59%
Beef patty, broiled, 3 ounces (85g)  | 5.3  | 48%
Cashews, dry roasted, 3 ounces (85g)  | 4.8  | 44%
Lobster, cooked, 3 ounces (85g)  | 3.4  | 31%
Pork chop, loin, cooked, 3 ounces (85g)  | 2.9  | 26%
Baked beans, canned, plain or vegetarian, ½ cup  | 2.9  | 26%
Almonds, dry roasted, 3 ounces (85g)  | 2.7  | 25%
Chicken, dark meat, cooked, 3 ounces (85g)  | 2.4  | 22%
Yogurt, fruit, low fat, 8 ounces (230g)  | 1.7  | 15%
Shredded wheat, unfortified, 1 cup[42] | 1.5  | 14%
Chickpeas, cooked, ½ cup  | 1.3  | 12%
Cheese, Swiss, 1 ounce (28g)  | 1.2  | 11%
Oatmeal, instant, plain, prepared with water, 1 packet  | 1.1  | 10%
Milk, low-fat or non-fat, 1 cup  | 1.0  | 9%
Kidney beans, cooked, ½ cup  | 0.9  | 8%
Chicken breast, roasted, skin removed, ½ breast  | 0.9  | 8%
Cheese, cheddar or mozzarella, 1 ounce (28g)  | 0.9  | 8%
Peas, green, frozen, cooked, ½ cup  | 0.5  | 5%
Flounder or sole, cooked, 3 ounces (85g)  | 0.3  | 3%

Recent research findings suggest that increasing atmospheric carbon dioxide concentrations will exacerbate zinc deficiency problems in populations that consume grains and legumes as Staple foods. A meta-analysis of data from 143 studies comparing the nutrient content of grasses and legumes grown in ambient and elevated CO2 environments found that the edible portions of wheat, rice, peas and soybeans grown in elevated CO2 contained less zinc and iron.[43] Global atmospheric CO2 concentration is expected to reach 550 p.p.m. in the late 21st century. At this CO2 level the zinc content of these crops was 3.3 to 9.3% lower than that of crops grown in the present atmosphere. A model of the nutritional impact of these lower zinc quantities on the populations of 151 countries predicts that an additional 175 million people could face dietary zinc deficiency as the result of increasing atmospheric CO2.[44]

### Absorption[edit | edit source]

Acrodermatitis enteropathica is an inherited deficiency of the zinc carrier protein ZIP4 resulting in inadequate zinc absorption.[9] It presents as growth retardation, severe diarrhea, hair loss, skin rash (most often around the genitalia and mouth) and opportunistic candidiasis and bacterial infections.[9]

Numerous small bowel diseases which cause destruction or malfunction of the gut mucosa enterocytes and generalized malabsorption are associated with zinc deficiency.[citation needed]

### Increased loss[edit | edit source]

Exercising, high alcohol intake, and diarrhea all increase loss of zinc from the body.[8][45] Changes in intestinal tract absorbability and permeability due, in part, to viral, protozoal, or bacteria pathogens may also encourage fecal losses of zinc.[46]

### Chronic disease[edit | edit source]

The mechanism of zinc deficiency in some diseases has not been well defined; it may be multifactorial.

Wilson's disease, sickle cell disease, chronic kidney disease, chronic liver disease have all been associated with zinc deficiency.[47][48] It can also occur after bariatric surgery, mercury exposure[49][50] and tartrazine.[citation needed]

Although marginal zinc deficiency is often found in depression, low zinc levels could either be a cause or a consequence of mental disorders and their symptoms. [29]

## Mechanism[edit | edit source]

LA to DGLA fatty acid pathway (Zinc deficiency-broken line)

As biosystems are unable to store zinc, regular intake is necessary. Excessively low zinc intake can lead to zinc deficiency, which can negatively impact an individual's health.[51] The mechanisms for the clinical manifestations of zinc deficiency are best appreciated by recognizing that zinc functions in the body in three areas: catalytic, structural, and regulatory.[40][52] Zinc (Zn) is only common in its +2 oxidative state, where it typically coordinates with tetrahedral geometry. It is important in maintaining basic cellular functions such as DNA replication, RNA transcription, cell division and cell activations. However, having too much or too little zinc can cause these functions to be compromised.

Zinc is a critical component of the catalytic site of hundreds of kinds of different metalloenzymes in each human being. In its structural role, zinc coordinates with certain protein domains, facilitating protein folding and producing structures such as 'zinc fingers'. In its regulatory role, zinc is involved in the regulation of nucleoproteins and the activity of various inflammatory cells. For example, zinc regulates the expression of metallothionein, which has multiple functions, such as intracellular zinc compartmentalization[53] and antioxidant function.[54][55] Thus zinc deficiency results in disruption of hundreds of metabolic pathways, causing numerous clinical manifestations, including impaired growth and development, and disruption of reproductive and immune function.[8][56][57]

Pra1 (pH regulated antigen 1) is a candida albicans protein that scavenges host zinc.[58]

## Diagnosis[edit | edit source]

Diagnosis is typically made based on clinical suspicion and a low level of zinc in the blood. Any level below 70 mcg/dl (normal 70-120 mcg/dl)is considered as zinc deficiency. Zinc deficiency could be also associated with low alkaline phosphatase since it acts a cofactor for this enzyme.

There is a paucity of adequate zinc biomarkers, and the most widely used indicator, plasma zinc, has poor sensitivity and specificity.[59]

### Classification[edit | edit source]

Zinc deficiency can be classified as acute, as may occur during prolonged inappropriate zinc-free total parenteral nutrition; or chronic, as may occur in dietary deficiency or inadequate absorption.[33]

## Prevention[edit | edit source]

Zinc gluconate tablets

Five interventional strategies can be used:

* Adding zinc to soil, called agronomic biofortification, which both increases crop yields and provides more dietary zinc.
* Adding zinc to food, called food fortification. The Republic of China, India, Mexico and about 20 other countries, mostly on the east coast of sub-Saharan Africa, fortify wheat flour and/or maize flour with zinc.[60]
* Adding zinc rich foods to diet. The foods with the highest concentration of zinc are proteins, especially animal meats, the highest being oysters.[8] Per ounce, beef, pork, and lamb contain more zinc than fish. The dark meat of a chicken has more zinc than the light meat. Other good sources of zinc are nuts, whole grains, legumes, and yeast.[61] Although whole grains and cereals are high in zinc, they also contain chelating phytates which bind zinc and reduce its bioavailability.[8]
* Oral repletion via tablets (e.g. zinc gluconate) or liquid (e.g. zinc acetate). Oral zinc supplementation in healthy infants more than six months old has been shown to reduce the duration of any subsequent diarrheal episodes by about 11 hours.[62]
* Oral repletion via multivitamin/mineral supplements containing zinc gluconate, sulfate, or acetate. It is not clear whether one form is better than another.[61]

## Epidemiology[edit | edit source]

Zinc deficiency affects about 2.2 billion people around the world.[23] Severe zinc deficiency is rare, and is mainly seen in persons with acrodermatitis enteropathica, a severe defect in zinc absorption due to a congenital deficiency in the zinc carrier protein ZIP4 in the enterocyte.[8] Mild zinc deficiency due to reduced dietary intake is common.[8] Conservative estimates suggest that 25% of the world's population is at risk of zinc deficiency.[39] Zinc deficiency is thought to be a leading cause of infant mortality.[citation needed]

Providing micronutrients, including zinc, to humans is one of the four solutions to major global problems identified in the Copenhagen Consensus from an international panel of economists.[63]

## History[edit | edit source]

Significant historical events related to zinc deficiency began in 1869 when zinc was first discovered to be essential to the growth of an organism Aspergillus niger.[64] In 1929 Lutz measured zinc in numerous human tissues using the dithizone technique and estimated total body zinc in a 70 kg man to be 2.2 grams. Zinc was found to be essential to the growth of rats in 1933.[65] In 1939 beriberi patients in China were noted to have decreased zinc levels in skin and nails. In 1940 zinc levels in a series of autopsies found it to be present in all tissues examined. In 1942 a study showed most zinc excretion was via the feces. In 1950 a normal serum zinc level was first defined, and found to be 17.3–22.1 micromoles/liter. In 1956 cirrhotic patients were found to have low serum zinc levels. In 1963 zinc was determined to be essential to human growth, three enzymes requiring zinc as a cofactor were described, and a report was published of a 21-year-old Iranian man with stunted growth, infantile genitalia, and anemia which were all reversed by zinc supplementation.[66] In 1972 fifteen Iranian rejected army inductees with symptoms of zinc deficiency were reported: all responded to zinc. In 1973 the first case of acrodermatitis enteropathica due to severe zinc deficiency was described. In 1974 the National Academy of Sciences declared zinc to be an essential element for humans and established a recommended daily allowance. In 1978 the Food and Drug Administration required zinc to be in total parenteral nutrition fluids. In the 1990s there was increasing attention on the role of zinc deficiency in childhood morbidity and mortality in developing countries.[67] In 2002 the zinc transporter protein ZIP4 was first identified as the mechanism for absorption of zinc in the gut across the basolateral membrane of the enterocyte. By 2014 over 300 zinc containing enzymes have been identified, as well as over 1000 zinc containing transcription factors.[citation needed]

Phytate was recognized as removing zinc from nutrients given to chicken and swine in 1960. That it can cause human zinc deficiency however was not recognized until Reinhold's work in Iran in the 1970s. This phenomenon is central to the high risk of zinc deficiency worldwide.[68]

## Farming[edit | edit source]

See also: Zinc deficiency (plant disorder)

Soil zinc is an essential micronutrient for crops. Almost half of the world's cereal crops are deficient in zinc, leading to poor crop yields.[69] Many agricultural countries around the world are affected by zinc deficiency.[70] In China, zinc deficiency occurs on around half of the agricultural soils, affecting mainly rice and maize. Areas with zinc deficient soils are often regions with widespread zinc deficiency in humans. A basic knowledge of the dynamics of zinc in soils, understanding of the uptake and transport of zinc in crops and characterizing the response of crops to zinc deficiency are essential steps in achieving sustainable solutions to the problem of zinc deficiency in crops and humans.[71]

### Biofortification[edit | edit source]

Soil and foliar application of zinc fertilizer can effectively increase grain zinc and reduce the phytate:zinc ratio in grain.[72][73] People who eat bread prepared from zinc enriched wheat have a significant increase in serum zinc.[citation needed]

Zinc fertilization not only increases zinc content in zinc deficient crops, it also increases crop yields.[71] Balanced crop nutrition supplying all essential nutrients, including zinc, is a cost effective management strategy. Even with zinc-efficient varieties, zinc fertilizers are needed when the available zinc in the topsoil becomes depleted.

Plant breeding can improve zinc uptake capacity of plants under soil conditions with low chemical availability of zinc. Breeding can also improve zinc translocation which elevates zinc content in edible crop parts as opposed to the rest of the plant.

Central Anatolia, in Turkey, was a region with zinc-deficient soils and widespread zinc deficiency in humans. In 1993, a research project found that yields could be increased by 6 to 8-fold and child nutrition dramatically increased through zinc fertilization.[74] Zinc was added to fertilizers. While the product was initially made available at the same cost, the results were so convincing that Turkish farmers significantly increased the use of the zinc-fortified fertilizer (1 percent of zinc) within a few years, despite the repricing of the products to reflect the added value of the content. Nearly ten years after the identification of the zinc deficiency problem, the total amount of zinc-containing compound fertilizers produced and applied in Turkey reached a record level of 300,000 tonnes per annum. It is estimated that the economic benefits associated with the application of zinc fertilizers on zinc deficient soils in Turkey is around US$100 million per year. Zinc deficiency in children has been dramatically reduced.

## References[edit | edit source]

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35. ↑ Sanstead HH, et al. (2000). "Zinc nutriture as related to brain". J. Nutr. 130: 140S–146S.
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37. ↑ Solomons NW (2001). "Dietary Sources of zinc and factors affecting its bioavailability". Food Nutr. Bull. 22 (2): 138–154. doi:10.1177/156482650102200204. S2CID 74543530.
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39. ↑ 39.0 39.1 Maret W, Sandstead HH (2006). "Zinc requirements and the risks and benefits of zinc supplementation". Journal of Trace Elements in Medicine and Biology. 20 (1): 3–18. doi:10.1016/j.jtemb.2006.01.006. PMID 16632171.
40. ↑ 40.0 40.1 "Zinc" Archived 19 September 2017 at the Wayback Machine, pp. 442–501 in Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academy Press. 2001.
41. ↑ Adapted from http://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/#h3 Archived 9 October 2021 at the Wayback Machine.
42. ↑ "Shredded wheat". eatthismuch.com. Archived from the original on 20 February 2019. Retrieved 20 February 2019.
43. ↑ Myers SS, Zanobetti A, Kloog I, Huybers P, Leakey AD, Bloom AJ, et al. (June 2014). "Increasing CO2 threatens human nutrition". Nature. 510 (7503): 139–42. Bibcode:2014Natur.510..139M. doi:10.1038/nature13179. PMC 4810679. PMID 24805231.
44. ↑ Smith MR, Myers SS (2018). "Impact of anthropogenic CO2 emissions on global human nutrition". Nature Climate Change. 8 (9): 834–839. Bibcode:2018NatCC...8..834S. doi:10.1038/s41558-018-0253-3. ISSN 1758-678X. S2CID 91727337. Archived from the original on 29 June 2021. Retrieved 11 October 2021.
45. ↑ Castillo-Duran C, Vial P, Uauy R (September 1988). "Trace mineral balance during acute diarrhea in infants". The Journal of Pediatrics. 113 (3): 452–7. doi:10.1016/S0022-3476(88)80627-9. PMID 3411389.
46. ↑ Manary MJ, Hotz C, Krebs NF, Gibson RS, Westcott JE, Arnold T, et al. (December 2000). "Dietary phytate reduction improves zinc absorption in Malawian children recovering from tuberculosis but not in well children". The Journal of Nutrition. 130 (12): 2959–64. doi:10.1093/jn/130.12.2959. PMID 11110854.
47. ↑ "zinc deficiency". GPnotebook.
48. ↑ Prasad AS (February 2003). "Zinc deficiency". BMJ. 326 (7386): 409–10. doi:10.1136/bmj.326.7386.409. PMC 1125304. PMID 12595353.
49. ↑ El-Safty IA, Gadallah M, Shafik A, Shouman AE (September 2002). "Effect of mercury vapour exposure on urinary excretion of calcium, zinc and copper: relationship to alterations in functional and structural integrity of the kidney". Toxicology and Industrial Health. 18 (8): 377–88. doi:10.1191/0748233702th160oa. PMID 15119526. S2CID 32876828.
50. ↑ Funk AE, Day FA, Brady FO (1987). "Displacement of zinc and copper from copper-induced metallothionein by cadmium and by mercury: in vivo and ex vivo studies". Comparative Biochemistry and Physiology. C, Comparative Pharmacology and Toxicology. 86 (1): 1–6. doi:10.1016/0742-8413(87)90133-2. PMID 2881702.
51. ↑ Prasad AS (March 2013). "Discovery of human zinc deficiency: its impact on human health and disease". Advances in Nutrition. 4 (2): 176–90. doi:10.3945/an.112.003210. PMC 3649098. PMID 23493534.
52. ↑ Cousins RJ (1994). "Metal elements and gene expression". Annual Review of Nutrition. 14: 449–69. doi:10.1146/annurev.nu.14.070194.002313. PMID 7946529.
53. ↑ Maret W (May 2003). "Cellular zinc and redox states converge in the metallothionein/thionein pair". The Journal of Nutrition. 133 (5 Suppl 1): 1460S–2S. doi:10.1093/jn/133.5.1460S. PMID 12730443.
54. ↑ Theocharis SE, Margeli AP, Koutselinis A (2003). "Metallothionein: a multifunctional protein from toxicity to cancer". Int J Biol Markers. 18 (3): 162–169. doi:10.1177/172460080301800302. PMID 14535585.
55. ↑ Theocharis SE, Margeli AP, Klijanienko JT, Kouraklis GP (August 2004). "Metallothionein expression in human neoplasia". Histopathology. 45 (2): 103–18. doi:10.1111/j.1365-2559.2004.01922.x. PMID 15279628. S2CID 41978978.
56. ↑ Kupka R, Fawzi W (March 2002). "Zinc nutrition and HIV infection". Nutrition Reviews. 60 (3): 69–79. doi:10.1301/00296640260042739. PMID 11908743.
57. ↑ Rink L, Gabriel P (November 2000). "Zinc and the immune system". The Proceedings of the Nutrition Society. 59 (4): 541–52. doi:10.1017/S0029665100000781. PMID 11115789.
58. ↑ Citiulo F, Jacobsen ID, Miramón P, Schild L, Brunke S, Zipfel P, et al. (2012). "Candida albicans scavenges host zinc via Pra1 during endothelial invasion". PLOS Pathogens. 8 (6): e1002777. doi:10.1371/journal.ppat.1002777. PMC 3386192. PMID 22761575.
59. ↑ Hambidge, M (2003). "Biomarkers of trace mineral intake and status". Journal of Nutrition. 133. 133 (3): 948S–955S. doi:10.1093/jn/133.3.948S. PMID 12612181.
60. ↑ "Map: Count of Nutrients in Fortification Standards". Food Fortification Initiative. 2018. Archived from the original on 11 April 2019. Retrieved 24 January 2019.
61. ↑ 61.0 61.1 "Zinc in diet: MedlinePlus Medical Encyclopedia". medlineplus.gov. 2 February 2015. Archived from the original on 22 February 2017. Retrieved 21 February 2017.
62. ↑ Lazzerini M, Wanzira H (December 2016). "Oral zinc for treating diarrhoea in children". The Cochrane Database of Systematic Reviews. 12: CD005436. doi:10.1002/14651858.CD005436.pub5. PMC 5450879. PMID 27996088.
63. ↑ "Copenhagen Consensus Center". Archived from the original on 26 August 2014. Retrieved 30 August 2014.
64. ↑ Raulin J (1869). "Chemical studies on vegetation". Annales des Sciences Naturelles. 11: 293–299.
65. ↑ Todd WR, Elvejheim CA, Hart EB (1934). "Zinc in the nutrition of the rat". Am J Physiol. 107: 146–156. doi:10.1152/ajplegacy.1933.107.1.146.
66. ↑ Prasad AS, Miale A, Farid Z, Sandstead HH, Schulert AR (April 1963). "Zinc metabolism in patients with the syndrome of iron deficiency anemia, hepatosplenomegaly, dwarfism, and hypognadism". The Journal of Laboratory and Clinical Medicine. 61: 537–49. PMID 13985937.
67. ↑ Duggan C, Watkins JB, Walker WA (2008). Nutrition in pediatrics : basic science, clinical application (4th ed.). Hamilton: BC Decker. pp. 69–71. ISBN 9781550093612. Archived from the original on 13 April 2021. Retrieved 11 October 2021.
68. ↑ Sandstead HH (January 2013). "Human zinc deficiency: discovery to initial translation". Advances in Nutrition. 4 (1): 76–81. doi:10.3945/an.112.003186. PMC 3648742. PMID 23319126.
69. ↑ Korayem, A.M. (1993). "Effect of zinc fertilization on rice plants and on the population of the rice-root nematode Hirschmanniella oryzae". Anz. Schadlingskde., Pflanzenschutz, Umweltschutz. 66: 18–21. doi:10.1007/BF01903608. S2CID 33142627.
70. ↑ "Archived copy". Archived from the original on 19 December 2008. Retrieved 23 April 2009.`{{cite web}}`: CS1 maint: archived copy as title (link)
71. ↑ 71.0 71.1 Alloway BJ (2008). "Zinc in Soils and Crop Nutrition, International Fertilizer Industry Association, and International Zinc Association". Archived from the original on 19 February 2013. Retrieved 15 December 2012.
72. ↑ Hussain S, Maqsood MA, Rengel Z, Aziz T (March 2012). "Biofortification and estimated human bioavailability of zinc in wheat grains as influenced by methods of zinc application". Plant and Soil. 361 (1–2): 279–290. doi:10.1007/s11104-012-1217-4. S2CID 16068957.
73. ↑ Fang Y, Wang L, Xin Z, Zhao L, An X, Hu Q (March 2008). "Effect of foliar application of zinc, selenium, and iron fertilizers on nutrients concentration and yield of rice grain in China". Journal of Agricultural and Food Chemistry. 56 (6): 2079–84. doi:10.1021/jf800150z. PMID 18311920.
74. ↑ Cakmak, I. (2008). "Enrichment of cereal grains with zinc: Agronomic or genetic biofortification?". Plant Soil. 302 (1–2): 1–17. doi:10.1007/s11104-007-9466-3. S2CID 34821888.

## External links[edit | edit source]

Classification|

* ICD-10: E60
* ICD-9-CM: 269.3
* DiseasesDB: 14272

|

* DermAtlas 228

* v
* t
* e

Diseases of the skin and appendages by morphology

Growths|

| Epidermal|

* Wart
* Callus
* Seborrheic keratosis
* Acrochordon
* Molluscum contagiosum
* Actinic keratosis
* Squamous-cell carcinoma
* Basal-cell carcinoma
* Merkel-cell carcinoma
* Nevus sebaceous
* Trichoepithelioma

|

Pigmented|

* Freckles
* Lentigo
* Melasma
* Nevus
* Melanoma

Dermal and
subcutaneous|

* Epidermal inclusion cyst
* Hemangioma
* Dermatofibroma (benign fibrous histiocytoma)
* Keloid
* Lipoma
* Neurofibroma
* Xanthoma
* Kaposi's sarcoma
* Infantile digital fibromatosis
* Granular cell tumor
* Leiomyoma
* Lymphangioma circumscriptum
* Myxoid cyst

Rashes|

| With
epidermal
involvement|

| Eczematous|

* Contact dermatitis
* Atopic dermatitis
* Seborrheic dermatitis
* Stasis dermatitis
* Lichen simplex chronicus
* Darier's disease
* Glucagonoma syndrome
* Langerhans cell histiocytosis
* Lichen sclerosus
* Pemphigus foliaceus
* Wiskott–Aldrich syndrome
* Zinc deficiency

|

Scaling|

* Psoriasis
* Tinea (Corporis
* Cruris
* Pedis
* Manuum
* Faciei)
* Pityriasis rosea
* Secondary syphilis
* Mycosis fungoides
* Systemic lupus erythematosus
* Pityriasis rubra pilaris
* Parapsoriasis
* Ichthyosis

Blistering|

* Herpes simplex
* Herpes zoster
* Varicella
* Bullous impetigo
* Acute contact dermatitis
* Pemphigus vulgaris
* Bullous pemphigoid
* Dermatitis herpetiformis
* Porphyria cutanea tarda
* Epidermolysis bullosa simplex

Papular|

* Scabies
* Insect bite reactions
* Lichen planus
* Miliaria
* Keratosis pilaris
* Lichen spinulosus
* Transient acantholytic dermatosis
* Lichen nitidus
* Pityriasis lichenoides et varioliformis acuta

Pustular|

* Acne vulgaris
* Acne rosacea
* Folliculitis
* Impetigo
* Candidiasis
* Gonococcemia
* Dermatophyte
* Coccidioidomycosis
* Subcorneal pustular dermatosis

Hypopigmented|

* Tinea versicolor
* Vitiligo
* Pityriasis alba
* Postinflammatory hyperpigmentation
* Tuberous sclerosis
* Idiopathic guttate hypomelanosis
* Leprosy
* Hypopigmented mycosis fungoides

Without
epidermal
involvement|

| Red|

| Blanchable
Erythema|

| Generalized|

* Drug eruptions
* Viral exanthems
* Toxic erythema
* Systemic lupus erythematosus

|

Localized|

* Cellulitis
* Abscess
* Boil
* Erythema nodosum
* Carcinoid syndrome
* Fixed drug eruption

Specialized|

* Urticaria
* Erythema (Multiforme
* Migrans
* Gyratum repens
* Annulare centrifugum
* Ab igne)

Nonblanchable
Purpura|

| Macular|

* Thrombocytopenic purpura
* Actinic/solar purpura

|

Papular|

* Disseminated intravascular coagulation
* Vasculitis

Indurated|

* Scleroderma/morphea
* Granuloma annulare
* Lichen sclerosis et atrophicus
* Necrobiosis lipoidica

Miscellaneous
disorders|

| Ulcers|

|

Hair|

* Telogen effluvium
* Androgenic alopecia
* Alopecia areata
* Systemic lupus erythematosus
* Tinea capitis
* Loose anagen syndrome
* Lichen planopilaris
* Folliculitis decalvans
* Acne keloidalis nuchae

Nail|

* Onychomycosis
* Psoriasis
* Paronychia
* Ingrown nail

Mucous
membrane|

* Aphthous stomatitis
* Oral candidiasis
* Lichen planus
* Leukoplakia
* Pemphigus vulgaris
* Mucous membrane pemphigoid
* Cicatricial pemphigoid
* Herpesvirus
* Coxsackievirus
* Syphilis
* Systemic histoplasmosis
* Squamous-cell carcinoma

* v
* t
* e

Malnutrition

Protein-energy
malnutrition|

* Kwashiorkor
* Marasmus
* Catabolysis

Vitamin deficiency|

| B vitamins|

* B1
* Beriberi
* Wernicke–Korsakoff syndrome
* Wernicke's encephalopathy
* Korsakoff's syndrome
* B2
* Riboflavin deficiency
* B3
* Pellagra
* B6
* Pyridoxine deficiency
* B7
* Biotin deficiency
* B9
* Folate deficiency
* B12
* Vitamin B12 deficiency

|

Other|

* A: Vitamin A deficiency
* Bitot's spots
* C: Scurvy
* D: Vitamin D deficiency
* Rickets
* Osteomalacia
* Harrison's groove
* E: Vitamin E deficiency
* K: Vitamin K deficiency

Mineral deficiency|

* Sodium
* Potassium
* Magnesium
* Calcium
* Iron
* Zinc
* Manganese
* Copper
* Iodine
* Chromium
* Molybdenum
* Selenium
* Keshan disease

Growth|

* Delayed milestone
* Failure to thrive
* Short stature
* Idiopathic

General|

* Anorexia
* Weight loss
* Cachexia
* Underweight

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*[t]: Discuss this template
*[e]: Edit this template