title: Serum trace elements in dysphagic gastrostomy candidates before endoscopic gastrostomy for long term enteral feeding.
abstract: Patients who underwent endoscopic gastrostomy (PEG) present protein-energy malnutrition, but little is known about Trace Elements (TE), Zinc (Zn), Copper (Cu), Selenium (Se), Iron (Fe), Chromium (Cr). Our aim was the evaluation of serum TE in patients who underwent PEG and its relationship with serum proteins, BMI and nature of underlying disorder.
  
  
  
  A prospective observational study was performed collecting: patient's age, gender, underlying disorder, NRS-2002, BMI, serum albumin, transferrin and TE concentration. We used ferrozine colorimetric method for Fe; Inductively Coupled Plasma-Atomic Emission Spectroscopy for Zn/Cu; Furnace Atomic Absorption Spectroscopy for Se/Cr. The patients were divided into head and neck cancer (HNC) and neurological dysphagia (ND).
  
  
  
  146 patients (89 males), 21-95 years: HNC-56; ND-90. Low BMI in 78. Low values mostly for Zn (n = 122) and Fe (n = 69), but less for Se (n = 31), Cu (n = 16), Cr (n = 7); low albumin in 77, low transferrin in 94 and 66 with both proteins low. Significant differences between the groups of underlying disease only for Zn (t140.326 = -2,642, p < 0.01) and a correlation between proteins and TE respectively albumin and Zn (r = 0.197, p = 0.025), and albumin and Fe (r = 0.415, p = 0.000).
  
  
  
  When gastrostomy was performed, patients display low serum TE namely Zn, but also Fe, less striking regarding others TE. It was related with prolonged fasting, whatever the underlying disease. Low proteins were associated with low TE. Teams taking care of PEG-patients should use Zn supplementation and include other TE evaluation as part of the nutritional assessment of PEG candidates.
authors.affiliation: GENE - Enteral Feeding Team, Hospital Garcia de Orta, Av. Professor Torrado da Silva, 2800 Almada, Portugal. Electronic address: carla.adriana.santos@hotmail.com.
authors.forename: Carla Adriana
authors.initials: CA
authors.lastname: Santos
authors.affiliation: GENE - Enteral Feeding Team, Hospital Garcia de Orta, Av. Professor Torrado da Silva, 2800 Almada, Portugal; CiiEM - Center for Interdisciplinary Research Egas Moniz, 2800 Almada, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Fonseca
authors.affiliation: Departamento das Ciências Naturais e Exatas, Área Científica de Matemática, Escola Superior de Tecnologias da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990 Lisboa, Portugal.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Carolino
authors.affiliation: Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; Serviço de Med 4/Hospital Santa Marta/Centro Hospitalar de Lisboa Central, Rua de Santa Marta, 50-1169-024 Lisboa, Portugal.
authors.forename: António Sousa
authors.initials: AS
authors.lastname: Guerreiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy; D003677:Deficiency Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D003680:Deglutition Disorders / Q000097:blood / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011174:Portugal / Q000453:epidemiology; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012306:Risk; D013054:Spectrophotometry, Atomic; D014131:Trace Elements / Q000097:blood / Q000172:deficiency*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D014131:Trace Elements
keywords: Dysphagia; Gastrostomy; Nutrition; PEG; Trace elements