Dietary zinc intake and whole blood zinc concentration in subjects with type 2 diabetes versus healthy subjects: A systematic review, meta-analysis and meta-regression

José C Fernández-Cao, Marisol Warthon-Medina, Victoria Hall Moran, Victoria Arija, Carlos Doepking, Nicola M Lowe

The aim of this systematic review, meta-analysis and meta-regression was to examine the relationship between type 2 diabetes mellitus (T2DM) and concentration of zinc in whole blood, as well as dietary zinc intake. Searches were performed using Ovid MEDLINE, Embase (Ovid) and The Cochrane Library (CENTRAL). Observational studies conducted on diabetic and healthy adults, with data on dietary zinc intake and/or concentration of zinc in whole blood, were selected. The search strategy yielded 11,150 publications and the manual search 6, of which 11 were included in the meta-analyses. Mean difference (MD) and 95% confidence interval (CI), were calculated using the generic inverse-variance method with random-effects models. Heterogeneity was assessed by the Cochran Q-statistic and quantified by the I2statistic. Meta-regressions and stratified analysis were used to examine whether any covariate had influence on the results. The pooled MD for the dietary zinc intake meta-analysis was -0.40 (95% CI: -1.59 to 0.79; I2 = 61.0%). Differences between diabetic and non-diabetic subjects became significant in the presence of complications associated with diabetes (MD = -2.26; 95% CI: -3.49 to -1.02; I2 = 11.9%). Meta-regression showed that for each year since the diagnosis of diabetes the concentration of zinc in whole blood decreased in diabetic patients regarding healthy controls [MD (concentration of zinc in blood) = 732.61 + (-77.88303) × (duration of diabetes in years)], which is not generally explained by a lower intake of zinc.