Effect of total parenteral nutrition on the zinc, copper, and manganese status of patients with catabolic disease

The zinc, copper, and manganese concentrations in liver and muscle and the serum zinc were measured in 24 malnourished patients before and after 10-12 days' parenteral nutrition with 3 different alimentation programs. The nutrition programs contained similar trace element substitutions. Malnutrition caused by different catabolic diseases resulted in an increase of zinc and copper contents in the liver and a rise of serum zinc in many patients and in a decrease of muscle zinc concentration in certain patients. Parenteral nutrition of any kind resulted in a decrease of liver zinc and copper content and of serum zinc, yielding subnormal zinc values in 25-58% of the patients in spite of a daily substitution of 1.9 mg zinc. There was no significant change in the manganese status because of malnutrition or parenteral alimentation. It is concluded that the serum zinc concentration does not show the real zinc status of the body in the patients with catabolism, that in certain catabolic diseases zinc and copper are redistributed to the liver, that certain catabolic diseases cause a zinc depletion of the muscle, that parenteral nutrition results in a fall of zinc and copper in the liver and in a decrease of serum zinc, which may be harmful from the healing point of view, and that the daily substitution of zinc used in this study, 1.9 mg/day, is not sufficient during parenteral nutrition of catabolic patients.