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Community and International Nutrition

Acute Phase Protein Levels, T. trichiura, and Maternal Education Are Predictors of Serum Zinc in a Cross-Sectional Study in Bangladeshi Children¹

² Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark; ³ International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B): Centre for Health and Population Research, Dhaka, Bangladesh; and ⁴ Department of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

^* To whom correspondence should be addressed. Email: kak{at}kvl.dk, katjakongsbak{at}yahoo.dk.

Zinc deficiency is a public health issue in Bangladesh. The objectives were to identify predictors of serum zinc concentration and to assess the prevalence of low serum zinc, in both the whole population, after correcting for the effect of serum C-reactive protein (CRP) (using multiple categories), and the healthy subgroup. A cross-sectional study was conducted among 579 apparently healthy 3-7 y old children from a Dhaka slum, Bangladesh. Using multiple linear regression, the effects of age, gender, serum CRP and ₁-antichymotrypsin, reported morbidity, Ascaris lumbricoides and Trichuris trichiura infections, parental education as well as stunting, underweight, and wasting on serum zinc were estimated. Serum zinc (mean ± SD) was 9.7 ± 1.1 µmol/L. Elevated serum CRP levels, T. trichiura infection, and stunting were negative predictors of serum zinc, whereas maternal education was a positive predictor. Compared with serum CRP <1 mg/L, CRP levels of 2 to <5, 5 to <10 and 10 mg/L were associated with 0.33, 0.73, and 0.89 µmol/L lower serum zinc, respectively. The prevalence of low serum zinc (<9.9 µmol/L) fell from 59.3 to 49.7% in the whole population, after correcting for the effect of CRP and was 50.0% in the healthy subgroup (CRP <2 mg/L). The prevalence of low serum zinc was high but overestimated due to the effect of the acute phase response. Interventions to address low serum zinc in Bangladesh are warranted. Controlling T. trichiura infection and improving maternal education may be important interventions. The use of multiple categories of acute phase proteins and cut-off values that indicate elevated levels warrant further research.