title: Cocoa supplementation for copper deficiency associated with tube feeding nutrition.
abstract: OBJECTIVE
  Because of an increasing number of case reports of copper deficiency associated with long-term tube feeding nutrition in Japan, we identified patients with copper deficiency associated with long-term tube feeding and described the prevalence, clinical data and cocoa treatment for these patients.
  
  
  METHODS
  We conducted a retrospective study to identify patients who were referred from long-term care institutions and had copper deficiency associated with tube feeding. We reviewed all serum copper concentration data during a 6-year period. We also compared admission and post-treatment peripheral blood counts.
  
  
  RESULTS
  Among 210 consecutive admissions with nutritional tube feeding from long-term care institutions (N=210), we identified 13 (6.2%) patients with copper deficiency (aged 46-91; 12 women). All patients had anemia, while most had neutropenia. The range of serum copper concentrations of these patients was 0.1-2.4 microg/L (normal; 6.8-12.8 microg/L). Their feeding formulas revealed a low copper content (5 to 12 microg per 100 kcal of each formula). Cocoa powder was used as the treatment. With cocoa supplements, the blood leukocyte count and hemoglobin significantly improved in all patients. Median leukocyte counts were 1,800 /mm(3)at admission and 6,300/mm(3) at follow-up (p=0.001). Median hemoglobin were 7.0 g/dl at admission and 10.3 g/dl at follow-up (p=0.001). Two patients developed transient tachycardia as a possible adverse effect of cocoa.
  
  
  CONCLUSIONS
  We identified many cases with copper deficiency associated with tube feeding in Okinawa, Japan. Cocoa supplement appeared to be a safe and effective treatment. Increasing the copper content of Japanese tube feeding formulas should be considered for its prevention.
authors.affiliation: Department of Medicine, St. Luke's International Hospital, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kashima
authors.forename: Mami
authors.initials: M
authors.lastname: Kayo
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Nakazato
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Stein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002099:Cacao / Q000009:adverse effects; D003300:Copper / Q000097:blood / Q000172:deficiency*; D003677:Deficiency Diseases / Q000097:blood / Q000178:diet therapy* / Q000453:epidemiology / Q000209:etiology*; D019587:Dietary Supplements / Q000009:adverse effects; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013610:Tachycardia / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D003300:Copper