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Original Research Communication |
1 From the US Department of Agriculture, Agricultural Research Service, Western Human Nutrition Research Center, University of California, Davis; the US Department of Agriculture Children's Nutrition Research Center, Baylor College of Medicine, Houston; and the Department of Medicine, University of Liverpool, Liverpool, United Kingdom.
2 Supported in part by a grant from the USDA Western Human Nutrition Research Center.
3 Address reprint requests to JC King, USDA/ARS, Western Human Nutrition Research Center, University of California, Davis, CA 95616. E-mail: jking{at}whnrc.usda.gov.
| ABSTRACT |
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Objective: The objective was to identify the homeostatic response to severe zinc depletion by using compartmental analysis.
Design: Stable zinc isotope tracers were administered intravenously to 5 men at baseline (12.2 mg dietary Zn/d) and after 5 wk of acute zinc depletion (0.23 mg/d). Compartmental modeling of zinc metabolism was performed by using tracer and mass data in plasma, urine, and feces collected over 614 d.
Results: The plasma zinc concentration fell 65% on average after 5 wk of zinc depletion. The model predicted that fractional zinc absorption increased from 26% to essentially 100%. The rate constants for zinc excretion in the urine and gastrointestinal tract decreased 96% and 74%, respectively. The rate constants describing the distribution kinetics of plasma zinc did not change significantly. When zinc depletion was simulated by using an average mass model of zinc metabolism at baseline, the only change that accounted for the observed fall in plasma zinc concentration was a 60% reduction in the rate constant for zinc release from the most slowly turning over zinc pool. The large changes in zinc intake, excretion, and absorptioneven when considered togetheronly explained modest reductions in plasma zinc mass.
Conclusion: The kinetic analysis with a compartmental model suggests that the profound decrease in plasma zinc concentrations after 5 wk of severe zinc depletion was mainly due to a decrease in the rate of zinc release from the most slowly turning over body zinc pool.
Key Words: Zinc depletion compartmental model kinetic analysis rate constants plasma zinc zinc homeostasis men
| INTRODUCTION |
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Compartmental models of zinc metabolism in humans have been formulated by using radioactive or stable-isotope tracers of zinc (812). Monitoring the oral and intravenous tracer data in plasma, urine, and fecal samples has allowed the development of models describing zinc absorption, fecal and urinary endogenous excretions, and the sizes and turnover rates of extravascular pools that exchange with plasma zinc. Using such a compartmental model of zinc metabolism, Wastney et al (9) identified 5 sites at which zinc homeostasis was regulated when zinc intake increased 11-fold: gastrointestinal zinc absorption, urinary zinc excretion, erythrocyte exchange of zinc, muscle zinc release, and secretion of zinc into the gut. These adjustments, along with a nearly 2-fold increase in the plasma zinc concentration, maintained normal physiologic function when there was an excess of zinc.
Similar studies of zinc metabolism and homeostasis in humans fed a zinc-deficient diet have not been conducted with the use of a compartmental model. Therefore, the purpose of the present study was to apply a mathematical model of zinc metabolism developed previously (11) to the tracer and tracee data in plasma, urine, and feces obtained from 5 men fed a diet virtually free of zinc to determine the relation between changes in plasma zinc, zinc absorption and excretion, and tissue zinc kinetics.
| SUBJECTS AND METHODS |
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Study design
The subjects were housed in a metabolic ward at the Western Human Nutrition Research Center (San Francisco) for 57 d. The study was divided into 2 metabolic periods: a 16-d baseline period in which 12.2 mg Zn/d was provided and a 41-d depletion period in which 0.23 mg Zn/d was provided. Intravenous stable-isotope tracers of zinc were administered on days 6 or 7 of the baseline period and at the end of the depletion period (day 35) to develop the mathematical model of zinc metabolism.
Body weight, temperature, and blood pressure were measured between 0700 and 0800 daily after the subjects' first urinary void in the morning. To maintain physical activity comparable with prestudy levels, the subjects walked 9.6 km (6 miles)/d at a brisk pace, 4.8 km (3 miles) in the morning and 3 mi (4.8 km) in the afternoon.
Diet
To provide a diet virtually free of zinc, an egg-albumin-based, semipurified formula diet adequate in all nutrients except zinc (4) was fed throughout the study (Table 2
). The basic formula provided 761 kJ/d, with 10% of the energy from protein, 60% from carbohydrate, and 30% from fat. The extra-energy formulacomposed of oil, sugar, and dextromaltosewas added to the basic formula in varying amounts to maintain a constant body weight. The total energy intake ranged from 155 to 192 kJ·kg-1·d-1. Each subject's protein intake was also adjusted for body weight by using egg albumin powder to provide
0.8 g protein/kg. The actual protein intake ranged from 0.7 to 1.2 g·kg-1·d-1. All adjustments in energy and protein intakes were made during the first 7 d; no further adjustments were made thereafter. Fiber (methylcellulose) was added to the formula to ensure regular fecal flow. A total of 4 g
-methylcellulose/d (1 g/meal) was given to all but one subject, who required 8 g/d to control constipation. Multivitamin tablets were taken once daily (Long's Daily Vitamin; Long's Drug Stores, Walnut Creek, CA). Trace mineralsexcept zinc, copper, and ironwere supplied as capsules (prepared by the University of California at San Francisco School of Pharmacy, Drug Product Services Laboratory) and were taken once daily. A solution of iron (FeSO4) and copper (CuSO4) providing a total daily intake of 10 mg Fe and the upper level of the estimated safe and adequate intake of copper, 3 mg/d, was added to the formula at each meal to ensure an adequate intake of those trace elements known to influence zinc metabolism. Likewise, a solution of ZnSO4 providing 12 mg Zn/d was added to the formula during the baseline period and withdrawn during the depletion period.
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The mean (±SD) daily zinc intake from the basic formula diet and all foods fed during the study (excluding the ZnSO4 solution) was 0.22 ± 0.07 mg/d.
Kinetic studies of zinc metabolism
Kinetic studies were performed in the middle of the baseline period (on day 7 in subjects 24 and on day 6 in subjects 10 and 11) and at the end of the depletion period (on day 27 in subject 2 and on day 35 in subjects 3, 4, 10, and 11). Subject 2 developed clinical symptoms of zinc deficiency (ie, erythematous dermatitis) by week 4 of depletion; therefore, the depletion kinetic studies were conducted earlier and zinc depletion was terminated on day 33. At baseline, 1.6 ± 0.06 mg tracer highly enriched in 67Zn was administered intravenously; 0.3 ± 0.02 mg tracer highly enriched in 70Zn was administered at the depletion time point. Before the intravenous tracer was injected, a catheter was placed in the opposite arm and was used for blood sampling (8.0 mL) at the following times after the tracer infusion: 2, 5, 10, 20, 30, 45, and 60 min and 2, 3, 6, 9, and 12 h. The catheter was removed after 12 h and additional blood samples were collected by venipuncture at 24, 48, 96, and 144 h. All samples were kept on ice until the plasma was separated by centrifugation at 1145 x g for 15 min at 4°C (Sorvall Instruments, Dupont Corp, Wilmington, DE) within 1 h of collection.
Preparation of stable-isotope tracers
Stable-isotope tracers of zinc, highly enriched in 67Zn (90.09% abundance) or 70Zn (85.03% abundance), were purchased as zinc oxide from Oak Ridge National Laboratory (Oak Ridge, TN). The tracers were prepared for intravenous administration as described previously (11). Sterilization, pyrogen testing, and packaging into individual, sealed, sterile vials were performed at the pharmacy of the University of California at San Francisco.
Sample collection and analysis
Twenty-fourhour urine and complete fecal samples were collected throughout the study. The zinc tracer concentration was measured in each plasma sample, in each complete 24-h urine collection for 7 d, and in each stool specimen for 14 d after administration. Precautions against environmental zinc contamination were taken for all diet, blood, and excreta collections and analysis. Before use, all glassware was acid washed in 10% nitric acid and rinsed 3 times with triply deionized water.
The total zinc content of the plasma, fecal, and urinary, samples was determined by AAS (Smith-Hieftje-22; Thermo Jarrell Ash, Franklin, MA). Plasma and urine samples were diluted with 0.125 mol nitric acid/L (trace metal grade; Fisher Scientific, Pittsburgh) before aspiration directly into the atomic absorption spectrophotometer as previously described in detail (11). Individual stool samples were freeze-dried to constant weight and ground to homogeneity. Weighed aliquots (0.2 g) were digested by using microwave digestion (MDS 2000; CEM Corporation, Matthews, NC) and the total zinc content was determined by AAS as previously described (11).
The ratios of zinc isotopes in plasma, urine, and fecal samples at baseline were determined by using inductively coupled plasma mass spectrometry (ICP-MS). Because the plasma zinc concentrations at depletion were low, isotope ratios were determined by magnetic sector thermal ionization mass spectrometry (model MAT 261; Finnigan, Bremen, Germany) in the laboratory of one of the authors (SAA). Detailed methods for the preparation of samples for ICP-MS were published elsewhere (11). In brief, plasma (34 mL) and freeze-dried fecal samples (0.30.5 g) were digested by using microwave digestion in 5 mL concentrated nitric acid (Fisher trace metal grade). Zinc was purified from the mineral digest by ion-exchange chromatography (type AGIX-8 ion exchange resin; Bio-Rad Laboratories, Mississauga, Canada). Urine samples were centrifuged (230 x g, 4°C, 10 min) and the inorganic salts were removed by using a chelating resin (Chelex 100 resin; Bio-Rad Laboratories); zinc was purified from the eluant by ion-exchange chromatography. Isotope ratios were expressed with respect to the nonenriched isotope, 66Zn, and corrected for temperature- and mass-specific differences in fractionation by using the ratio of 64Zn to 66Zn. Ten scans were performed per block, and replicate blocks were repeated until the desired degree of precision (<0.2%) was obtained.
Isotope ratios of baseline plasma samples and of all urinary and fecal samples were measured by using a Sciex ELAN 500 ICP-MS instrument (Perkin-Elmer, Norwalk, CT) equipped with a U-5000AT ultrasonic nebulizer (Cetac Technologies Inc, Omaha) and a model 212B autosampler (Gilson Medical Electronics Inc, Middleton, WI).
Treatment of stable-isotope tracer data for kinetic analysis
All isotope ratios were converted to tracer-tracee ratios (mg/mg) for kinetic analysis by using 66Zn as the reference isotope as previously described (11). Although the tracer-tracee ratios in plasma were used directly in the kinetic analysis, those for the urine and feces were first converted to tracer amount (mg) and expressed as cumulative tracer in urine and feces. Finally, the zinc concentrations in plasma, urine, and fecal samples measured by AAS were corrected for tracer mass as previously described (11).
Kinetic analysis
The compartmental model used to analyze the zinc tracer and steady state mass data is shown in Figure 1
. This model is a simplification of that used previously to analyze a double-isotope tracer study in humans (11), which itself was a simplification of a more elaborate compartmental model of zinc metabolism (9, 10). In the current study, only a single intravenous isotope tracer was administered. The circles represent kinetically distinct pools of zinc (mg); the arrows represent the rate constants (per day) of the model, where ki,j is defined as the fraction of tracer or tracee in pool j being transported to pool i per day; the numeral 0 refers to irreversible losses in urine or feces.
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The fractional turnover rate of compartment 5, referred to as the proximal gastrointestinal tract and equal to the sum of k1,5 and k6,5 was not determinable from our data because no oral tracer was administered. Consequently, we assumed a value for the fractional turnover rate of compartment 5 equal to the average value previously reported from our group of 6 female subjects: 6.42/d (11). Fractional zinc absorption (FZA) was then estimated as k1,5/6.42. The absolute magnitude of the assumed fractional turnover rate of compartment 5 had no significant effect on any measures of zinc metabolism obtained from our model including FZA. Because no oral tracer was given, we were also unable to separate endogenous zinc secretion into the gastrointestinal tract from endogenous zinc excretion into the feces. Consequently, endogenous zinc secretion was set equal to endogenous zinc excretion in our model even though it is known that the former is greater than the latter. Finally, the infrequency of stool samples in either of the tracer studies at baseline or depletion for a given subject led to poorly determinable values for the mean transit time through the distal gastrointestinal tract, 1/k0,6. This problem was resolved by assuming values for k0,6 to be determinable from the data in a given subject but invariant between the baseline and depletion studies. Any errors in determining k0,6 would not have any significant effect on any of the measures of zinc metabolism extracted from the compartmental model.
The baseline and depletion tracer studies were analyzed concurrently subject to 2 constraints that linked the fitting process between the 2 data sets. First, the plasma volume was assumed to be invariant between the 2 tracer studies (body weight remained constant), the implication being that the plasma zinc mass is proportional to the average plasma zinc concentration calculated from all of the plasma zinc concentration measurements obtained during each tracer experiment. The second constraint, as described above, assumes that the fractional turnover rate of the distal gastrointestinal tract (k0,6) is estimable from both sets of tracer data but invariant between baseline and depletion.
The plasma zinc masses at baseline and depletion were calculated directly in the fitting process and used as the input information for calculating the steady state solutions. Mass flux information, including dietary intakes and measurements of urinary and fecal zinc excretion, were used in the data array as added constraints on the fit of the model to the tracer data.
Two sets of the model in Figure 1
were fitted concurrently to the baseline and depletion tracer and mass data for each participant subject to the above-mentioned constraints. Data were fit by using SAAM II (version 1.2; SAAM Institute, Seattle), a program that uses a weighted, nonlinear, least-squares parameter estimation algorithm. Measurement errors were assumed to be independent and Gaussian with a mean of 0 and a fractional SD of 0.1. Weights were chosen optimally, ie, equal to the inverse of the variance of the measurement error. The precision of the parameter estimates was determined from the covariance matrix at the least-squares fit.
To gain some insight into the possible mechanism underlying the changes in plasma zinc mass during zinc depletion, an average zinc model was formulated by using the mean values for the rate constants for the 5 subjects at baseline. The steady state solution for this average baseline model was calculated and the various compartmental mass values were assigned to their respective compartments as initial conditions, thereby formulating a mass model of zinc metabolism at baseline. Simulations over 35 d on this mass model were then performed under conditions of low zinc intake and with various changes in rate constants to their depletion values to determine the relative importance of these changes, taken individually and together, in explaining the fall in plasma zinc mass.
Statistics
Differences between the mean values (n = 5) of the rate constants and steady state measures for the baseline and depletion states were evaluated by using paired t tests. Significance was defined as P
0.05.
| RESULTS |
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The total zinc lost from the body, estimated by balance measures, during the entire 5-wk depletion (Table 3
) averaged 54.7 ± 18.4 mg, of which 18.9 ± 10.6 mg could be accounted for by the movement of unabsorbed dietary zinc into the feces during the early phase of the depletion process. The difference of
36 mg represented the net zinc loss from the body during depletion, an amount enough lower than the 60-mg decrease in mass of the total EZP (Table 5
) to at least suggest the possibility of zinc sequestration in the very slowest turning over zinc pool during the depletion period. At the very least, our analysis indicates the absence of any significant decrease in size of this very slowly turning over zinc pool during acute depletion.
To identify those model parameters that account for the bulk of the decline in plasma zinc mass during depletion, we used the average mass model (see Methods) to perform simulations over a 35-d period corresponding to the interval during which zinc intake was reduced from a baseline value of >12 mg/d to a depletion value of 0.22 mg/d. The decrease in zinc intake by itself, ie, no changes in baseline rate constants, resulted in a modest 16% decrease in plasma zinc mass by day 35, from 3.36 to 2.81 mg, whereas the measured plasma zinc mass actually declined by 65% to 1.17 mg. When the increases in FZA and decreases in fractional zinc losses from plasma to urine and feces (corresponding to the depletion values) were added to the simulation model on day 1 of depletion and were maintained throughout the depletion period, the decrease in plasma zinc mass from baseline to day 35 was even more modest (only 4%), from 3.36 to 3.22 mg. When the values for the rate constants of the equilibrating zinc pools 2 and 3 were changed to their depletion values immediately at the beginning of the simulation process and when the changes cited above were taken into account, the plasma zinc mass fell to 2.98 mg at day 35, an 11% decrease. Finally, when k1,7 at baseline (0.015/d) was changed to its depletion value (0.006/d) at the beginning of the simulation and was considered together with all of the other changes cited above, the plasma mass decreased significantly by day 35 to 1.22 mg, a decrease of 64% from baseline. This reduction in simulated plasma zinc mass was similar to that actually seen (M1 fell from 3.36 to 1.17 mg; Table 5
).
| DISCUSSION |
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Zinc tracer kinetics have not been studied in humans during severe depletion. However, the effect of dietary zinc loading on zinc tracer kinetics was previously investigated (9, 15). In contrast with our findings, supplementation with 100 mg Zn for 910 mo caused marked reductions in FZA and increases in gastrointestinal and urinary zinc excretion and rate of release of zinc from slowly turning over zinc stores. The signals for adjusting zinc utilization at these sites are unknown. The sites in gut and kidney are probably under separate feedback control (1). Studies in experimental animals and humans showed that changes in endogenous fecal zinc excretion occur quickly with a low zinc intake but have a relatively limited capacity to change (5, 16). Adjustments in FZA take longer to occur but can cope with larger fluctuations in zinc intake. Adjustments in urinary zinc excretion occur only when zinc intakes are very low, <3 mg/d (3), or very high (15). A shift in the ratio of glucagon to insulin may be one of several mechanisms causing a change in renal tubular zinc transport (16, 17).
To gain some insight into the mechanism by which the plasma zinc mass fell by 65% in 35 d, we formulated a dynamic model of zinc mass movement based on the average values of the rate constants from the tracer model at baseline along with the associated steady state solution. Once formulated, changes in rate constants from baseline to depletion could be tested individually and collectively to determine their effects on plasma zinc mass. Selected rate constants at baseline were changed to their depletion values at the beginning of a 35-d simulation by using compartmental masses at baseline as initial conditions. The model was solved for the next 35 d of severe depletion, subject to the very low zinc intake, and the changes in plasma zinc mass were generated over time. The only simulation that came close to explaining the decrease in plasma zinc mass from 3.36 to 1.17 mg was the change in k1,7 from a baseline value of 0.015 to 0.006 per day. All other changes in rate constants, including those describing the equilibrating zinc pools 2 and 3, the increase in FZA, and the decreases in fractional plasma zinc losses into feces and urine produced only modest decreases in plasma zinc mass by day 35. Our analysis suggests that the most slowly turning over zinc pools, depicted in our model as compartment 7, are sensitive to extreme reductions in zinc intake. The changes in rate constants between compartments 1 and 3 also have an acute, significant effect on reductions in plasma zinc mass, but that effect was dissipated over a 35-d time span because the turnover time of compartment 3 was <1 d, ie, a new equilibrium was reestablished between M1 and M3 in a few days. The effect of a change in the rate constants between compartments 1 and 2 on plasma zinc mass was even more evanescent because the turnover time of compartment 2 was <1 h.
The skeletal muscle, which contains
60% of the whole-body zinc (7), is likely to be a major component of compartment 7 (18). Studies of growing experimental animals showed that the skeletal muscle conserves zinc even when the animals are fed diets so deficient in zinc that growth ceases and protein synthesis is severely impaired (1820). Our data and analysis suggest that zinc release in muscle also declines in men consuming diets severely restricted in zinc. The relatively rapid response of this slowly turning over pool to a deficient zinc intake also suggests that the tissue signal is not local cellular zinc deficiency or a reduction in circulating zinc concentrations. Possibly, the signaling pathways of the endocrine receptors are altered early in zinc depletion. McNall et al (21) reported that the impaired growth in zinc-deficient rats is associated with a decreased expression of hepatic insulin-like growth factor I and the growth hormone receptor genes. Further studies of the underlying mechanisms mediating tissue zinc conservation with depletion are needed.
In our acute depletion study, the 65% decrease in the plasma zinc concentration was about twice that of the percentage decrease in the total EZP (from 166 to 106 mg), whereas in more modest, or chronic, zinc-depletion states, plasma zinc concentrations did not decline significantly even though the total EZP was lower (22). Possibly, plasma zinc concentrations stabilize at normal or near-normal concentrations under conditions of chronic low zinc intakes because of changes in gastrointestinal absorption and excretion, which require months rather than weeks for complete equilibration with all extraplasma zinc pools to occur. Furthermore, there also may be a change in the rate constants of the plasma equilibrating pools that results in a decrease in the total EZP, but over a time span measured in months rather than weeks and therefore not reflected in a tracer experiment performed during the first 5 wk of acute zinc depletion. If this process is confirmed, estimates of the total EZP may turn out to be a good reflection of zinc status with a long-term low zinc intake, whereas the plasma zinc concentration may be a better marker of acute, severe depletion. Nevertheless, neither of these markers, in absolute terms, should be considered a totally reliable marker of either chronic or acute zinc deficiency without further study.
In sum, this kinetic study of zinc metabolism showed that acute, severe zinc depletion increased FZA to essentially unity and decreased the excretion of zinc into the feces and urine by 91% and 99%, respectively. No significant changes in the plasma distribution rate constants were detected, suggesting that the kinetics of the zinc pools is not an effective means of determining zinc status during acute depletion. Although the total EZP decreased significantly, the percentage reduction was only about one-half that of the plasma mass, suggesting that the plasma zinc concentration is a better indicator of zinc status than is the size of the total EZP in acute depletion. Within the context of our compartmental model of zinc metabolism, the 65% decrease in plasma mass that occurred over a 5-wk period of severe zinc restriction could only be explained by a marked reduction in the rate of zinc release into the plasma from the large very slowly turning over zinc pool.
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