Zinc deficiency - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Zinc deficiency is rarely severe and usually congenital. Milder zinc deficiency is usually acquired and is common in older people.
Manifestations of zinc deficiency may be subtle and can affect many organ systems. Delayed wound healing, impaired taste, loss of appetite, hair loss, fertility issues, and increased susceptibility to infection are common manifestations.
Plasma or serum zinc levels are useful in the evaluation of patients with suspected zinc deficiency. Milder forms of zinc deficiency may not be detected in plasma or serum tests, but supplementation may still be considered for patients with typical symptoms.
In most cases, standard oral zinc supplementation leads to increased zinc levels and amelioration of symptoms.
Zinc supplementation is generally safe, although acute toxicity with high doses may lead to adverse changes in immune, iron, copper, and cholesterol status, as well as to potential genitourinary problems.

Acrodermatitis enteropathica on the face seen with severe zinc deficiency

Adapted from Maverakis E, Lynch PJ, Fazel N. Acrodermatitis enteropathica. Dermatol Online J. 2007;13:11; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Acrodermatitis enteropathica seen with severe zinc deficiency
Acrodermatitis enteropathica on the face seen with severe zinc deficiency

Citations

Key Articles

Goh J, O'Morain CA. Review article: nutrition and adult inflammatory bowel disease. Aliment Pharmacol Ther. 2003 Feb;17(3):307-20.[Abstract][Full Text]
Goh J, O'Morain CA. Review article: nutrition and adult inflammatory bowel disease. Aliment Pharmacol Ther. 2003 Feb;17(3):307-20.[Abstract][Full Text]
Prasad AS. Zinc deficiency. BMJ. 2003 Feb 22;326(7386):409-10.[Abstract][Full Text]
Meunier N, O'Connor JM, Maiani G, et al. Importance of zinc in the elderly: the ZENITH study. Eur J Clin Nutr. 2005 Nov;59 Suppl 2:S1-4.[Abstract][Full Text]
Ackland ML, Michalczyk A. Zinc deficiency and its inherited disorders - a review. Genes Nutr. 2006 Mar;1(1):41-9. [Abstract]
Lassi ZS, Kurji J, Oliveira CS, et al. Zinc supplementation for the promotion of growth and prevention of infections in infants less than six months of age. Cochrane Database Syst Rev. 2020 Apr 8;4:CD010205.[Abstract][Full Text]
Haase H, Overbeck S, Rink L. Zinc supplementation for the treatment or prevention of disease: current status and future perspectives. Exp Gerontol. 2008 May;43(5):394-408. [Abstract]
Haider BA, Bhutta ZA. The effect of therapeutic zinc supplementation among young children with selected infections: a review of the evidence. Food Nutr Bull. 2009 Mar;30(1 suppl):S41-59.[Abstract][Full Text]

Other Online Resources

NIH Office of Dietary Supplements fact sheet for health professionals: zinc
Medline Plus: zinc in diet

Referenced Articles

1. Singhal N, Alam S, Sherwani R, et al. Serum zinc levels in celiac disease. Indian Pediatr. 2008 Apr;45(4):319-21.[Abstract]
2. Goh J, O'Morain CA. Review article: nutrition and adult inflammatory bowel disease. Aliment Pharmacol Ther. 2003 Feb;17(3):307-20.[Abstract][Full Text]
3. Ojuawo A, Keith L. The serum concentrations of zinc, copper and selenium in children with inflammatory bowel disease. Cent Afr J Med. 2002 Sep-Oct;48(9-10):116-9.[Abstract]
4. Narkewicz MR, Krebs N, Karrer F, et al. Correction of hypozincemia following liver transplantation in children is associated with reduced urinary zinc loss. Hepatology. 1999 Mar;29(3):830-3.[Abstract][Full Text]
5. Stamoulis I, Kouraklis G, Theocharis S. Zinc and the liver: an active interaction. Dig Dis Sci. 2007 Jul;52(7):1595-612. [Abstract]
6. Chausmer AB. Zinc, insulin and diabetes. J Am Coll Nutr. 1998 Apr;17(2):109-15.[Abstract]
7. Zheng Y, Li XK, Wang Y, et al. The role of zinc, copper and iron in the pathogenesis of diabetes and diabetic complications: therapeutic effects by chelators. Hemoglobin. 2008;32(1-2):135-45. [Abstract]
8. Nagalla S, Ballas SK. Drugs for preventing red blood cell dehydration in people with sickle cell disease. Cochrane Database Syst Rev. 2018 Oct 19;10:CD003426.[Abstract][Full Text]
9. Kalantar-Zadeh K, Kopple JD. Trace elements and vitamins in maintenance dialysis patients. Adv Ren Replace Ther. 2003 Jul;10(3):170-82.[Abstract]
10. Mahajan SK. Zinc in kidney disease. J Am Coll Nutr. 1989 Aug;8(4):296-304.[Abstract]
11. Prasad AS. Zinc deficiency in patients with sickle cell disease. Am J Clin Nutr. 2002 Feb;75(2):181-2.[Abstract][Full Text]
12. Koch J, Neal EA, Schlott MJ, et al. Zinc levels and infections in hospitalized patients with AIDS. Nutrition. 1996 Jul-Aug;12(7-8):515-8.[Abstract]
13. Kupka R, Fawzi W. Zinc nutrition and HIV infection. Nutr Rev. 2002 Mar;60(3):69-79.[Abstract]
14. Singhal N, Alam S, Sherwani R, et al. Serum zinc levels in celiac disease. Indian Pediatr. 2008 Apr;45(4):319-21.[Abstract]
15. Goh J, O'Morain CA. Review article: nutrition and adult inflammatory bowel disease. Aliment Pharmacol Ther. 2003 Feb;17(3):307-20.[Abstract][Full Text]
16. Ojuawo A, Keith L. The serum concentrations of zinc, copper and selenium in children with inflammatory bowel disease. Cent Afr J Med. 2002 Sep-Oct;48(9-10):116-9.[Abstract]
17. Narkewicz MR, Krebs N, Karrer F, et al. Correction of hypozincemia following liver transplantation in children is associated with reduced urinary zinc loss. Hepatology. 1999 Mar;29(3):830-3.[Abstract][Full Text]
18. Stamoulis I, Kouraklis G, Theocharis S. Zinc and the liver: an active interaction. Dig Dis Sci. 2007 Jul;52(7):1595-612. [Abstract]
19. Mahajan SK. Zinc in kidney disease. J Am Coll Nutr. 1989 Aug;8(4):296-304.[Abstract]
20. Perrone L, Gialanella G, Giordano V, et al. Impaired zinc metabolic status in children affected by idiopathic nephrotic syndrome. Eur J Pediatr. 1990 Mar;149(6):438-40.[Abstract]
21. Chausmer AB. Zinc, insulin and diabetes. J Am Coll Nutr. 1998 Apr;17(2):109-15.[Abstract]
22. Zheng Y, Li XK, Wang Y, et al. The role of zinc, copper and iron in the pathogenesis of diabetes and diabetic complications: therapeutic effects by chelators. Hemoglobin. 2008;32(1-2):135-45. [Abstract]
23. Prasad AS. Zinc deficiency in patients with sickle cell disease. Am J Clin Nutr. 2002 Feb;75(2):181-2.[Abstract][Full Text]
24. Koch J, Neal EA, Schlott MJ, et al. Zinc levels and infections in hospitalized patients with AIDS. Nutrition. 1996 Jul-Aug;12(7-8):515-8.[Abstract]
25. Kupka R, Fawzi W. Zinc nutrition and HIV infection. Nutr Rev. 2002 Mar;60(3):69-79.[Abstract]
26. Kang YJ, Zhou Z. Zinc prevention and treatment of alcoholic liver disease. Mol Aspects Med. 2005 Aug-Oct;26(4-5):391-404.[Abstract]
27. Rico H. Alcohol and bone disease. Alcohol Alcohol. 1990;25(4):345-52.[Abstract]
28. Hambidge KM, Krebs NF. Zinc deficiency: a special challenge. J Nutr. 2007 Apr;137(4):1101-5.[Abstract][Full Text]
29. Atik OS, Uslu MM, Eksioglu F, et al. Etiology of senile osteoporosis: a hypothesis. Clin Orthop Relat Res. 2006 Feb;443:25-7.[Abstract]
30. Haase H, Mocchegiani E, Rink L. Correlation between zinc status and immune function in the elderly. BBiogerontology. 2006 Oct-Dec;7(5-6):421-8.[Abstract]
31. Prasad AS. Zinc deficiency. BMJ. 2003 Feb 22;326(7386):409-10.[Abstract][Full Text]
32. Meunier N, O'Connor JM, Maiani G, et al. Importance of zinc in the elderly: the ZENITH study. Eur J Clin Nutr. 2005 Nov;59 Suppl 2:S1-4.[Abstract][Full Text]
33. Prasad AS, Beck FW, Bao B, et al. Zinc supplementation decreases incidence of infections in the elderly: effect of zinc on generation of cytokines and oxidative stress. Am J Clin Nutr. 2007 Mar;85(3):837-44.[Abstract][Full Text]
34. Ackland ML, Michalczyk A. Zinc deficiency and its inherited disorders - a review. Genes Nutr. 2006 Mar;1(1):41-9. [Abstract]
35. Bhatnagar S, Natchu UC. Zinc in child health and disease. Indian J Pediatr. 2004 Nov;71(11):991-5.[Abstract]
36. Prasad AS, Miale A Jr, Farid Z, et al. Zinc metabolism in patients with the syndrome of iron deficiency anemia, hepatosplenomegaly, dwarfism, and hypogonadism. J Lab Clin Med. 1963 Apr;61:537-49.[Abstract]
37. Müller O, Krawinkel M. Malnutrition and health in developing countries. CMAJ. 2005 Aug 2;173(3):279-86.[Abstract][Full Text]
38. Jameson S. Coeliac disease, insulin-like growth factor, bone mineral density, and zinc. Scand J Gastroenterol. 2000 Aug;35(8):894-6.[Abstract]
39. Altuntas B, Filik B, Ensari A, et al. Can zinc deficiency be used as a marker for the diagnosis of celiac disease in Turkish children with short stature? Pediatr Int. 2000 Dec;42(6):682-4.[Abstract]
40. El-Tawil AM. Zinc deficiency in men with Crohn's disease may contribute to poor sperm function and male infertility. Andrologia. 2003 Dec;35(6):337-41.[Abstract]
41. Shen YC, Chang YH, Fang CJ, et al. Zinc supplementation in patients with cirrhosis and hepatic encephalopathy: a systematic review and meta-analysis. Nutr J. 2019 Jul 6;18(1):34.[Abstract][Full Text]
42. Tumer N, Baskan S, Arcasoy A, et al. Hypozincemia in nephrotic syndrome. Clin Nephrol. 1991 Mar;35(3):135-7.[Abstract]
43. Stec J, Podracka L, Pavkovcekova O, et al. Zinc and copper metabolism in nephrotic syndrome. Nephron. 1990;56(2):186-7.[Abstract]
44. Mafra D, Cuppari L, Favaro DI, et al. Zinc levels after iron supplementation in patients with chronic kidney disease. J Ren Nutr. 2004 Jul;14(3):164-9.[Abstract]
45. Yuzbasiyan-Gurkan VA, Brewer GJ, Vander AJ, et al. Net renal tubular reabsorption of zinc in healthy man and impaired handling in sickle cell anemia. Am J Hematol. 1989 Jun;31(2):87-90.[Abstract]
46. Salgueiro MJ, Krebs N, Zubillaga MB, et al. Zinc and diabetes mellitus: is there a need of zinc supplementation in diabetes mellitus patients? Biol Trace Elem Res. 2001 Sep;81(3):215-28.[Abstract]
47. El Dib R, Gameiro OL, Ogata MS, et al. Zinc supplementation for the prevention of type 2 diabetes mellitus in adults with insulin resistance. Cochrane Database Syst Rev. 2015;(5):CD005525.[Abstract][Full Text]
48. Visser ME, Durao S, Sinclair D, et al. Micronutrient supplementation in adults with HIV infection. Cochrane Database Syst Rev. 2017;(5):CD003650.[Abstract][Full Text]
49. Freiberg MS, Cheng DM, Gnatienko N, et al. Effect of Zinc Supplementation vs Placebo on Mortality Risk and HIV Disease Progression Among HIV-Positive Adults With Heavy Alcohol Use: A Randomized Clinical Trial. JAMA Netw Open. 2020 May 1;3(5):e204330.[Abstract][Full Text]
50. Siegfried N, Irlam JH, Visser ME, et al. Micronutrient supplementation in pregnant women with HIV infection. Cochrane Database Syst Rev. 2012;(3):CD009755.[Abstract]
51. Zima T, Fialova L, Mestek O, et al. Oxidative stress, metabolism of ethanol and alcohol-related diseases. J Biomed Sci. 2001 Jan-Feb;8(1):59-70.[Abstract]
52. Chaudhry AA, Warthan MM, Pariser RJ, et al. Acquired acrodermatitis enteropathica secondary to alcoholism. Cutis. 2008 Jul;82(1):60-2.[Abstract]
53. West BL, Anderson PC. Alcohol and acquired acrodermatitis enteropathica. J Am Acad Dermatol. 1986 Dec;15(6):1305.[Abstract]
54. Hunt JR. Moving toward a plant-based diet: are iron and zinc at risk? Nutr Rev. 2002 May;60(5 Pt 1):127-34.[Abstract]
55. Donovan UM, Gibson RS. Iron and zinc status of young women aged 14 to 19 years consuming vegetarian and omnivorous diets. J Am Coll Nutr. 1995 Oct;14(5):463-72.[Abstract]
56. Gardner CD, Kim S, Bersamin A, et al. Micronutrient quality of weight-loss diets that focus on macronutrients: results from the A TO Z study. Am J Clin Nutr. 2010 Aug;92(2):304-12.[Abstract][Full Text]
57. Lutter CK, Rivera JA. Nutritional status of infants and young children and characteristics of their diets. J Nutr. 2003 Sep;133(9):2941S-9S.[Abstract][Full Text]
58. Lindberg L, Ostberg M, Isacson IM, et al. Feeding disorders related to nutrition. Acta Paediatr. 2006 Apr;95(4):425-9.[Abstract]
59. Castro J, Deulofeu R, Gila A, et al. Persistence of nutritional deficiencies after short-term weight recovery in adolescents with anorexia nervosa. Int J Eat Disord. 2004 Mar;35(2):169-78.[Abstract]
60. Das JK, Kumar R, Salam RA, et al. Systematic review of zinc fortification trials. Ann Nutr Metab. 2013;62(suppl 1):44-56.[Abstract][Full Text]
61. Shah D, Sachdev HS, Gera T, et al. Fortification of staple foods with zinc for improving zinc status and other health outcomes in the general population. Cochrane Database Syst Rev. 2016;(6):CD010697.[Abstract][Full Text]
62. Stewart CP, Christian P, LeClerq SC, et al. Antenatal supplementation with folic acid + iron + zinc improves linear growth and reduces peripheral adiposity in school-age children in rural Nepal. Am J Clin Nutr. 2009 Jul;90(1):132-40.[Abstract][Full Text]
63. Mayo-Wilson E, Junior JA, Imdad A, et al. Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years of age. Cochrane Database Syst Rev. 2014;(5):CD009384.[Abstract][Full Text]
64. Garcia-Guerra A, Neufeld LM, Hernandez-Cordero S, et al. Prenatal multiple micronutrient supplementation impact on biochemical indicators during pregnancy and postpartum. Salud Publica Mex. 2009 Jul-Aug;51(4):327-35.[Abstract][Full Text]
65. Carducci B, Keats EC, Bhutta ZA. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2021 Mar 16;3:CD000230.[Abstract][Full Text]
66. Lassi ZS, Kurji J, Oliveira CS, et al. Zinc supplementation for the promotion of growth and prevention of infections in infants less than six months of age. Cochrane Database Syst Rev. 2020 Apr 8;4:CD010205.[Abstract][Full Text]
67. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans, 2020-2025. Dec 2020 [internet publication].[Abstract][Full Text]
68. Troesch B, van Stujivenberg ME, Smuts CM, et al. A micronutrient powder with low doses of highly absorbable iron and zinc reduces iron and zinc deficiency and improves weight-for-age Z-scores in South African children. J Nutr. 2011 Feb;141(2):237-42.[Abstract][Full Text]
69. DiGirolamo AM, Ramirez-Zea M, Wang M, et al. Randomized trial of the effect of zinc supplementation on the mental health of school-age children in Guatemala. Am J Clin Nutr. 2010 Nov;92(5):1241-50. [Abstract][Full Text]
70. Lassi ZS, Moin A, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database Syst Rev. 2016;(12):CD005978.[Abstract][Full Text]
71. Aggarwal R, Sentz J, Miller MA. Role of zinc administration in prevention of childhood diarrhea and respiratory illnesses: a meta-analysis. Pediatrics. 2007 Jun;119(6):1120-30.[Abstract]
72. Haase H, Overbeck S, Rink L. Zinc supplementation for the treatment or prevention of disease: current status and future perspectives. Exp Gerontol. 2008 May;43(5):394-408. [Abstract]
73. Gibson RS, Hess SY, Hotz C, et al. Indicators of zinc status at the population level: a review of the evidence. Br J Nutr. 2008 Jun;99(suppl 3):S14-23.[Abstract]
74. Kodama H, Tanaka M, Naito Y, et al. Japan's Practical Guidelines for Zinc Deficiency with a Particular Focus on Taste Disorders, Inflammatory Bowel Disease, and Liver Cirrhosis. Int J Mol Sci. 2020 Apr 22;21(8):.[Abstract][Full Text]
75. Kumbargere Nagraj S, George RP, Shetty N, et al. Interventions for managing taste disturbances. Cochrane Database Syst Rev. 2017 Dec 20;12:CD010470.[Abstract][Full Text]
76. Hess SY, King JC. Effects of maternal zinc supplementation on pregnancy and lactation outcomes. Food Nutr Bull. 2009 Mar;30(1 suppl):S60-78.[Abstract][Full Text]
77. Shah D, Sachdev HP. Zinc deficiency in pregnancy and fetal outcome. Nutr Rev. 2006 Jan;64(1):15-30.[Abstract]
78. Carducci B, Keats EC, Bhutta ZA. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2021 Mar 16;3:CD000230.[Abstract][Full Text]
79. Stewart CP, Christian P, LeClerq SC, et al. Antenatal supplementation with folic acid + iron + zinc improves linear growth and reduces peripheral adiposity in school-age children in rural Nepal. Am J Clin Nutr. 2009 Jul;90(1):132-40.[Abstract][Full Text]
80. Heaney RP. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr. 2004 Dec;80(6 suppl):1706S-9S.[Abstract][Full Text]
81. Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7(5):439-43.[Abstract]
82. Hambidge M. Human zinc deficiency. J Nutr. 2000;130(5S suppl):1344S-1349S.[Abstract][Full Text]
83. Centers for Disease Control and Prevention. Guidelines for evaluation of the nutritional status and growth in refugee children during the domestic medical screening examination. Oct 2019 [internet publication].[Full Text]
84. Kodama H, Tanaka M, Naito Y, et al. Japan's Practical Guidelines for Zinc Deficiency with a Particular Focus on Taste Disorders, Inflammatory Bowel Disease, and Liver Cirrhosis. Int J Mol Sci. 2020 Apr 22;21(8):.[Abstract][Full Text]
85. Vakili R, Vahedian M, Khodaei GH, et al. Effects of zinc supplementation in occurrence and duration of common cold in school aged children during cold season: a double-blind placebo-controlled trial. Iran J Pediatr. 2009;19:376-80.[Full Text]
86. Lazzerini M, Wanzira H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2016;(12):CD005436.[Abstract][Full Text]
87. Mazariegos M, Hambidge KM, Westcott JE, et al. Neither a zinc supplement nor phytate-reduced maize nor their combination enhance growth of 6- to 12-month-old Guatemalan infants. J Nutr. 2010 May;140(5):1041-8.[Abstract][Full Text]
88. Chang S, El AS, Bari S, et al. Supplementing iron and zinc: double blind, randomized evaluation of separate or combined delivery. Eur J Clin Nutr. 2010 Feb;64(2):153-60. [Abstract][Full Text]
89. Institute of Medicine (U.S.). Panel on Micronutrients. DRI: Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Chapter 12: zinc. Washington, DC: National Academy Press; 2001:442-501.[Full Text]
90. Sriram K, Lonchyna VA. Micronutrient supplementation in adult nutrition therapy: practical considerations. JPEN J Parenter Enteral Nutr. 2009 Sep-Oct;33(5):548-62.[Abstract]
91. Wang LJ, Wang MQ, Hu R, et al. Effect of Zinc Supplementation on Maintenance Hemodialysis Patients: A Systematic Review and Meta-Analysis of 15 Randomized Controlled Trials. Biomed Res Int. 2017;2017:1024769.[Abstract][Full Text]
92. Haider BA, Bhutta ZA. The effect of therapeutic zinc supplementation among young children with selected infections: a review of the evidence. Food Nutr Bull. 2009 Mar;30(1 suppl):S41-59.[Abstract][Full Text]
93. Fischer Walker C, Black RE. Zinc and the risk for infectious disease. Annu Rev Nutr. 2004;24:255-75.[Abstract]
94. Valentiner-Branth P, Shrestha PS, Chandyo RK, et al. A randomized controlled trial of the effect of zinc as adjuvant therapy in children 2-35 mo of age with severe or nonsevere pneumonia in Bhaktapur, Nepal. Am J Clin Nutr. 2010 Jun;91(6):1667-74.[Abstract][Full Text]
95. Yakoob MY, Theodoratou E, Jabeen A, et al. Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria. BMC Public Health. 2011 Apr 13;11(suppl 3):S23. [Abstract][Full Text]
96. Imdad A, Bhutta ZA. Effect of preventive zinc supplementation on linear growth in children under 5 years of age in developing countries: a meta-analysis of studies for input to the lives saved tool. BMC Public Health. 2011 Apr 13;11(suppl 3):S22.[Abstract][Full Text]
97. Cole CR, Lifshitz F. Zinc nutrition and growth retardation. Pediatr Endocrinol Rev. 2008 Jun;5(4):889-96.[Abstract]
98. Brown KH, Peerson JM, Baker SK, et al. Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull. 2009 Mar;30(1 suppl):S12-40.[Abstract][Full Text]
99. Black MM. The evidence linking zinc deficiency with children's cognitive and motor functioning. J Nutr. 2003 May;133(5 suppl 1):1473S-6S.[Abstract][Full Text]
100. Sayeg Porto MA, Oliveira HP, Cunha AJ, et al. Linear growth and zinc supplementation in children with short stature. J Pediatr Endocrinol Metab. 2000 Sep-Oct;13(8):1121-8.[Abstract][Full Text]
101. Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutr. 2006;46(8):621-8.[Abstract]