Serum Levels of Selenium, Calcium, Copper Magnesium, Manganese and Zinc in Various Human Diseases1 JAMES F. SULLIVAN, ALAN J. BLOTCKY, MARY M. JETTON, HENRY K. J. HAHN 2 ANDROBERT E. BURGH 2 Trace Element Laboratories, Veterans Administration Medical Center, Omaha, Nebraska 68105 ABSTRACT Serum selenium as well as serum zinc, copper, magnesium, calcium and manganese were investigated in a control group of adult males and in 11 groups of patients in various disease states. Not only the change of each trace element but also the possible association between elements was studied in the various groups. All patients were fasting when sampled and studied only after the acute phase of the disease was corrected. Trace metal determinations were performed by atomic absorption spectrophotometry (Mg, Ca, Cu, Zn) and by neutron activation analysis (Se, Mn). All patients showed low serum zinc when compared to controls. Cirrhotic patients had a low serum selenium level as well as low calcium, magnesium and zinc. Emphysemia and cancer patients had an elevated serum copper concentration while copper and manganese levels were elevated in confestive heart failure, infection and psychoses. To our knowledge this is the rst time low serum selenium values have been demonstrated to be associ ated with the low serum zinc, calcium and magnesium levels found in cirrhotic patients. J. Nutr. 109: 1432-1437, 1979. INDEXING KEY WORDS serum selenium • trace elements cirrhosis Many elements, although present in minute quantities in man, are essential nutrients. Their presence was long overlooked and it has only been in recent years that analytical techniques capable of measuring such trace levels were developed. These elements perform functions indispensable to maintenance of life, growth and reproduction. Inadequate levels of some elements may impair cellular and physiological function or cause illness while other elements, even though present in low concentration, Numerous

of die metal by dialysis against a chelating agent may decrease the activity to zero, In addition to the vital role that trace elements play in enzymatic reactions, they have been examined critically as a potential key factor in varied diseases including cancer and cardiovascular disease.3 Al though trace elements are only a part of the total picture, they are important in the relationship of nutrition and maintenance of health as well as in the prevention of

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Received for publication November 29, 1978. a Small

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SERUM TRACE ELEMENTS

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IN DISEASE

disease. The evaluation of the role trace Nebraska, were hospitalized for a minimum elements play in health and disease be of 2 weeks and received a normal hospital comes more difficult when it is recognized diet. The analysis of selenium in the water that there are not only nutritional but also supplied to the area was < 0.005 ppm as metabolic interactions among the trace ele analyzed and reported by the Metropolitan ments themselves. There have been several Utilities District of Omaha, Nebraska. The reports of interactions between the trace analysis of selenium in the prepared hos pital meals ranged from 33.2 to 46.2 fig/ elements and vitamins as well. The literature contains many publica meal. The average amount of selenium tions relating trace element content to dis consumed per day by the patient was 117 ease states ( 1-12 ) but to the authors /*g. This value from analysis of meals very knowledge, selenium, which has been sug closely matched the amount of selenium gested to play an important role in cancer calculated to be present by the dietetic and other diseases, ( 13-19 ) has never been service of the hospital. Patients were cate included in an experimental determination gorized according to the usual criteria for of multiple elements in various disease physical diagnosis and classified into 11 groups according to the primary diagnosis states. The purpose of this study is to determine as seen in table 1. Informed consent was serum selenium levels in a variety of human obtained from each and this study con diseases, and to investigate the possibility formed to the principals embodied in the of an interrelationship between these levels Declaration of Helsinki. and changes in other trace elements which The patients were studied only after the often accompany and may modify a de acute phases of the disease, e.g., shock, ficiency or excess in a single element (20). acidosis, alkalosis and hypoglycemia were It is hoped that this information will add corrected. The etiology of the cirrhosis was to the general knowledge of the metab evaluated clinically and by liver biopsy in olism of selenium in man and thereby help which the histological criteria of alcohol in the eventual evolution of the role sele related liver disease was demonstrated. nium and other trace elements alone or in Blood was obtained from both patients concert may play in disease. and controls after an overnight fast. The METHODS blood was drawn into plastic syringes fitted A total of 185 male patients ranging in with stainless steel needles, immediately age from 20 to 80 years were studied. All transferred to metal-free tubes, allowed to patients resided in the area of Omaha, clot, centrifuged and the serum removed TABLE 1 Serum trace element content in disease Diagnosis Control (37)'COPD» (22)Cirrhosis (14)Alcohol/Pan

Zinc

Copper

Magnesium

Calcium

Manganese

Selenium

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±2.0919.28±3.0918.09±2.2319.07 (13)ASHD/CHF' creatitis ±0.030.12 ±0.11°0.61 (42)Malignancy ±nl8.295.416.94°8.114.2187.6 ±0.030.11 ±0.14°0.70±0.15«0.78±0.21«0.69 ±0.37°1.29 5891.9±89.2 ±11. (20)Hypertension ±0.030.13±0.030.13±0.050.12±0.030.12 ±0.281.33 ±1.8718.79±5.7719.08±2.1618.56±2.5620.05 (9)Diabetes ±0.421.36±0.17k1.20±0.171.35±0.411.32±0.22'