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Malnutrition and Inflammation-Induced Abnormal Serum Trace Element Concentration in the Patients with Pharyngeal Diseases Who Has Received Enough Trace Elements Intake by Enteral Nutrition $100.00
Authors:  Hitoshi Obaraa, Yasuka Tomiteb and Mamoru Doic
Abstract:
Tube-fed patients with pharyngeal diseases are receiving enough trace elements by intake of enteral formula including rich trace elements. However, serum trace elements concentration shows a low level even if patients are receiving enough trace elements intake. Since trace elements in serum bind to serum protein, serum trace elements concentration is influenced by serum protein concentration. In addition, synthesis of serum protein in the liver is increased or decreased by malnutrition and inflammation. Especially, tube-fed patients with pharyngeal diseases due to stroke are at high risk of malnutrition and aspiration pneumonia. Therefore, evaluation of serum trace elements concentration has to consider influence of malnutrition and inflammation.
The trace elements binding protein of the zinc, iron, and copper is albumin, transferrin, and ceruloplasmin, respectively. Serum trace elements concentration positively correlates to each trace elements binding protein. In the case of malnutrition, serum zinc, iron and copper concentration shows low level according to decrease of each trace elements binding protein concentration. In the case of inflammation, synthesis of albumin and transferrin are decreased, and serum zinc and iron concentration shows low level. In addition, synthesis of ceruloplasmin is increased, and serum copper concentration shows high level. In the patient with inflammation, serum trace elements concentration normalized with decrease of inflammatory response. As for frequency of abnormal serum trace element concentration in patients with pharyngeal diseases who received tube feeding, low serum zinc concentration was 65%, low serum iron concentration was 43%, and high serum copper concentration was 45%. Most of these patients developed hypoalbuminemia and inflammation. In the analysis of nutritional indices that are predictors of serum trace elements in patients with neurological dysphagia on long-term tube feeding, the predictor of serum zinc concentration was albumin, the predictors of serum iron concentration was transferrin and hemoglobin, the predictors of serum copper concentration was ceruloplasmin and C-reactive protein. The serum zinc, iron, and copper concentration were not correlated to each trace elements intake.
In conclusion, abnormal serum trace element concentration in the patients with pharyngeal diseases who has received enough trace elements is induced by malnutrition and inflammation. Iron is required for the synthesis of hemoglobin. Zinc is required for immunocompetence and wound healing. Management of trace elements is extremely important to maintain a good condition for patients. To normalize serum trace element concentration, we recommend treatment of malnutrition and aspiration pneumonia as well as increase in trace elements intake. 


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Malnutrition and Inflammation-Induced Abnormal Serum Trace Element Concentration in the Patients with Pharyngeal Diseases Who Has Received Enough Trace Elements Intake by Enteral Nutrition