title: Serum zinc evolution in dysphagic patients that underwent endoscopic gastrostomy for long term enteral feeding.
abstract: OBJECTIVE
  Patients undergoing endoscopic gastrostomy (PEG) present with protein-energy malnutrition (PEM) but little is known about zinc status. Our aim was to evaluate serum zinc, its relationship with serum proteins and with the nature of the underlying disorder, during the first 3 months of PEG feeding.
  
  
  METHODS
  Prospective observational study during a 3-month period after gastrostomy. Data was collected at initial PEG procedure (T0), after 4 (T1) and 12 weeks (T3). Initial evaluation included: age, gender, disorder causing dysphagia, Neurological Dysphagia (ND) or Head and Neck Cancer (HNC), NRS-2002, BMI, albumin, transferrin, zinc. At T1 and T3, a blood sample was collected for zinc, albumin, transferrin. Serum zinc evaluation was performed with ICP-AES - Inductively Coupled Plasma-Atomic Emission Spectroscopy. Patients were fed with homemade meals.
  
  
  RESULTS
  A total of 146 patients (89 males), 21-95 years were studied: HNC-56, ND-90 and low BMI in 78. Initial low zinc in 122; low albumin in 77, low transferrin in 94; low values for both proteins in 66. Regarding the serum protein evolution, their levels increase T0-T3, most patients reaching normal values. zinc has a slower evolution, most patients still displaying low zinc at T3. Significant differences between the 3 moments for zinc (p=0.011), albumin (p<0.0001) and transferrin (p=0.014).
  
  
  CONCLUSIONS
  PEG patients are prone to PEM and zinc deficiency. Most patients present decreased zinc, suggesting that zinc deficiency is common in PEG candidates and is not corrected during 3 months of enteral feeding. Zinc deficiency should be expected and teams taking care of PEG patients should use zinc supplementation.
authors.affiliation: GENE-Enteral Feeding Team, Hospital Garcia de Orta, Almada, Portugal. Email: 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, Almada, Portugal.|CiiEM-Center for Interdisciplinary Research Egas Moniz, Almada, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Fonseca
authors.affiliation: Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Maria Teresa Martins
authors.initials: MT
authors.lastname: Lopes
authors.affiliation: Departamento das Ciências Naturais e Exatas, Escola Superior de Tecnologias da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, 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, Lisbon, Portugal.|Serviço de Medicina 4/Hospital Santa Marta/Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: António Sousa
authors.initials: AS
authors.lastname: Guerreiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000097:blood* / Q000209:etiology; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000150:complications; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000209:etiology*; D012709:Serum Albumin / Q000032:analysis; D014168:Transferrin / Q000032:analysis; D015032:Zinc / Q000097:blood* / Q000172:deficiency
chemical_list: D012709:Serum Albumin; D014168:Transferrin; D015032:Zinc