Next Article in Journal
Indirect Calorimetry to Measure Metabolic Rate and Energy Expenditure in Psychiatric Populations: A Systematic Review
Previous Article in Journal
Vitamin D and Its Analogues: From Differences in Molecular Mechanisms to Potential Benefits of Adapted Use in the Treatment of Alzheimer’s Disease
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Nutrients
Volume 15
Issue 7
10.3390/nu15071685
nutrients-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Study on the Zinc Nutritional Status and Risk Factors of Chinese 6–18-Year-Old Children

by
Jiaxi Lu
†,
Huidi Zhang
†,
Wei Cao
,
Shan Jiang
,
Hongyun Fang
,
Dongmei Yu
and
Lichen Yang
*
Key Laboratory of Trace Element Nutrition, National Health Commission of the People’s Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Nutrients 2023, 15(7), 1685; https://doi.org/10.3390/nu15071685
Submission received: 17 February 2023 / Revised: 21 March 2023 / Accepted: 28 March 2023 / Published: 30 March 2023
(This article belongs to the Section Micronutrients and Human Health)
Versions Notes

Abstract

:
Zinc is an essential micronutrient that is involved in several metabolic processes, especially children’s growth and development. Although many previous studies have evaluated the zinc nutritional status of children, there are very few reports on children aged 6–18 years old. Furthermore, there are few reports on children’s zinc nutrition status based on the Chinese population. According to WHO data, the prevalence of zinc deficiency in Asian countries is rather high and has resulted in high child mortality. In this study, we aimed to comprehensively assess zinc nutritional status and the prevalence of zinc deficiency among children aged 6–18 years in China based on nationally representative cross-sectional data. Subgroup comparisons were made under possible influencing factors. The potential risk factors of zinc deficiency were also discussed. A total of 64,850 children, equally male and female, were recruited from 150 monitoring sites in 31 provinces through stratified random sampling from China National Nutrition and Health Survey of Children and Lactating Mothers (CNNHS 2016–2017). Median and interquartile intervals were used to represent the overall zinc concentration levels and different subgroups. A Chi-square test was used to compare serum zinc levels and the prevalence of zinc deficiency in children under different group variables. In order to study the influencing factors of zinc deficiency, multiple logistic regression was utilized. It was found that the median concentration of serum Zn was 88.39 μg/dL and the prevalence of Zn deficiency was 9.62%. The possible influence factors for Zn deficiency were sex, anemia, nutritional status, city type and income. By conducting a subgroup analysis of the factors, it was found that males; those with anemia, stunting and low income; and children living in rural areas have a higher risk of Zn deficiency. This study offers a comprehensive analysis of Zn nutritional status among Chinese children, which provides reliable data for policy formulation to improve the zinc nutrition status of children.

1. Introduction

Zinc (Zn) is the second most abundantly traced element in the body [1]. It is an essential cofactor required for a number of functions, for example, it catalyzes more than 100 enzymes’ activity, facilitates protein folding, and regulates gene expression [2]. According to a report by the World Health Organization (WHO) [3], Zn deficiency due to malnutrition ranks 11th among the major risk factors contributing to the global burden of disease. Early in the 20th century, severe zinc deficiency was identified as a syndrome marked by anorexia, hypogonadism, immune system impairment, skin abnormalities, and cognitive dysfunction [4]. In 1926, Lutz et al. used the dithizone technique for the first time to estimate the total zinc content of a 70 kg man to be 2.2 g. By 2004, the International Zinc Nutrition Consultative Group (IZiNCG) proposed a method for the comprehensive assessment of human zinc nutritional status [5]. More and more evidence shows that zinc may play an important role in a series of metabolic and chronic diseases in the body. Despite the rarity of severe zinc deficiency, mild-to-moderate zinc deficiencies are relatively widespread worldwide. Zn deficiency affects around one-third of the world’s population, with estimates varying from 4% to 73% depending on the subregion, with the vast majority occurring in developing countries in Africa and Asia [6,7]. In 2002, 1.4% (0.8 million) of fatalities were linked to zinc deficiency [3]. It has been reported that zinc deficiency has a greater impact on children and adolescents, which can cause growth retardation and even the death of children [8,9,10]. In 2011, 116 000 child fatalities were attributable to zinc deficiency, which affects an estimated 17% of the world’s population [11,12]. The main indicator for determining zinc insufficiency in people is serum zinc.
The lack of concern about zinc deficiency in children has been a widespread obstacle. Understanding children’s zinc nutritional status and zinc deficiency under different nutritional conditions is crucial for the future of global health policy. In this study, we aimed to conduct a comprehensive assessment of zinc nutrition in Chinese children aged 6–18 years based on a nationally representative cross-sectional study. The deficiency of zinc in whole and different subgroups was also explored. At the same time, we also discuss the possible risk factors of zinc deficiency.

2. Materials and Methods

2.1. Subjects

All the subjects were enrolled from the China National Nutrition and Health Survey of Children and Lactating Mothers (CNNHS 2016–2017), which is a national representative cross-sectional survey [13]. All the participants were selected from a total of 150 monitoring sites in 31 provinces across the country by stratified, multistage and random selection methods. Children aged 6–17 y were selected from schools in each monitoring site, half boys and half girls. Thus, the results are nationally, city type and regionally representative.
Biological index values below the detection limit, samples with incomplete questionnaire responses, and poor blood quality (such as hemolysis) were also excluded. In this study, 64,850 samples were finally included for analysis. All participants and their guardian were given their written consent after being fully informed. The Ethics Review Board of NINH, China CDC, approved the protocol (No. 201614).

2.2. Basic Information and Sample Collection

Basic demographic data (including age, sex, address, etc.) were gathered by consistently trained investigators using a standardized questionnaire. Additionally, the regional types of the subjects were classified accordingly [14]. Anthropometric measures were also taken by skilled medical personnel using defined protocols. Measurements of height and weight are part of the physical examination [15]. Weight and height were measured to the nearest 0.1 kg and centimeter using the Seca 877 electronic flat scale and the Seca 213 portable height bar gauge, respectively. During the measurements, the subject was required to remove their shoes, hats, and coats, and females untied their braids to ensure the accuracy of measurements. Body mass index (BMI) is calculated as weight (kg)/height (m2) squared. The nutritional status of children can be divided into stunting, wasting, normal, overweight and obesity. Stunting and wasting were defined according to the Chinese screening standards for malnutrition of school-age children and adolescents (WS/T 456—2014) ,c [16]. Additionally, the overweight and obesity of children were defined according to the Chinese screening standards for malnutrition of school-age children and adolescents (WS/T 586—2018) [17].
After at least 10 h of fasting, venous blood was drawn in the morning. Each blood sample was separated into an anticoagulant tube and a serum separator tube. Between 20 and 30 min after the blood was drawn, serum separator tubes containing blood samples were immediately centrifuged at 1500× g for 15 min. Afterward, the sera were separated and stored at −70 °C for further testing.

2.3. Serum Zn and Hemoglobin (Hb) Laboratory Analyses and Evaluation Standards

Inductively coupled plasma mass spectrometry (ICP-MS, PerkinElmer, NexION 350, Waltham, MA, USA) was used to detect the amounts of zinc. The precision and accuracy of the analysis were checked with the quality control samples (Seronorm, Level-2, Billingstad, Norway). Zn deficiency was defined as a serum Zn concentration lower than 70 μg/dL for girls and 74 μg/dL for boys according to the recommendation of The International Zinc Nutrition Consultative Group (IZiNCG) [18].
Hemoglobin was detected using a Sysmex XE-2100 hematology analyzer (Sysmex Corporation, Kobe, Japan) [19]. Additionally, anemia was defined according to the method of anemia screening (see [20]), as a Hb level lower than 115 g/L for ages 6–12 y, 120 g/L for ages 12–15 y in boys and in 15–18 y girls, 130 g/L for ages 15–18 y in boys. Because the Hb value is affected by the altitude of the long-term living area and increases with the rapid rise of altitude, we adjusted the hemoglobin value of people living at an altitude above 1000 m for more than half a year.

2.4. Data Analyses

For all data cleaning and analysis, SAS 9.4 (SAS Institute Inc., Cary, NC, USA) was utilized. Finally, the serum zinc content was represented as the median and interquartile range (IQR) for an abnormal distribution, and Kruskal–Wallis was used to compare the differences between the groups. The prevalence of serum zinc deficiency in children with various features was compared using the chi-square test. The multivariate logistic regression model was used to evaluate the variables affecting zinc nutrition. The value for statistical significance was set at p less than 0.05.

3. Results

3.1. Serum Zinc Concentration of Children

The serum Zn concentrations of children are shown in Table 1. A total of 64,850 children had a median Zn level of 88.39 μg/dL and the interquartile interval ranged from 80.00 to 98.80 μg/dL. By comparing the serum zinc levels among different subgroups, it was found that the distribution differences of serum zinc according to sex, age group, anemia status, nutritional status, city type, district and income were statistically significant. In sex groups, females (88.00 μg/dL) had a lower Zn level than males (89.00 μg/dL). Children in the 12–18-years-old category (89.00 μg/dL) had a higher Zn concentration than 6–11-year-olds (88.00 μg/dL). There was a large difference in zinc concentration among children with anemia (86.40 μg/dL) and without anemia (88.84 μg/dL). Among the different nutritional statuses, zinc level gradually increased from stunting (86.00 μg/dL) to obesity (91.00 μg/dL). Meanwhile, there were statistical differences between the two comparisons, except that there was no difference in zinc levels between wasting and normal. In the comparation of city type, Zn level was higher in children who live in a city (89.70 μg/dL) than in children who live rurally (87.30 μg/dL). From east to west, Zn concentration gradually decreased from 90.59 μg/dL to 86.00 μg/dL. Additionally, there was a statistical difference between the comparison of both districts. Similarly, with the reduction in family income, the zinc level gradually decreased. Children who live with an income of less than CNY 7500 had the lowest Zn level, 86.00 μg/dL, while children who live with an income greater than CNY 20,000 had the highest Zn level, 89.00 μg/dL. The Zn concentration in children with a family income lower than CNY 12,500 yuan was significantly different to children with a family income of CNY 12,500~20,000 and higher than CNY 20,000.

3.2. The Prevalence of Zinc Deficiency in 6–18-Year-Old Chinese Children

The prevalence of zinc deficiency analysis in Chinese children is shown in Table 2. A total of 6320 children were identified through screening as having a zinc deficiency. Additionally, the prevalence of Zn deficiency was 9.62% (95%CI 9.22–10.00%). Consistent with the distribution of zinc level, the difference in zinc deficiency among different subgroups is also statistically significant. In the comparison of sex groups, males (11.14%) had a higher prevalence of Zn deficiency than females (7.86%). The difference in Zn deficiency according to age group was consistent with that of Zn concentration. Children aged 6–11 y (10.44%) suffered with zinc deficiency more than those aged 12–18 y (8.85%). Having anemia also increased the risk of zinc deficiency; children with anemia had a higher prevalence of Zn deficiency than children without anemia (10.88% vs. 9.54%). Contrary to the trend of zinc concentration, the prevalence of zinc deficiency gradually increased with nutritional status from stunting (13.55%) to obesity (8.02%). There was no difference in zinc deficiency between the overweight and obesity groups. However, there were statistical differences in zinc deficiency rates among the other two comparisons. Children in rural areas (10.92%) had a higher prevalence of Zn deficiency compared to children living in cities (8.20%). In the comparison of districts, different from the distribution of serum zinc levels, children who live in a central area (12.36%) had the highest prevalence of zinc deficiency. Additionally, children who live in an eastern area (6.15%) had the lowest prevalence of Zn deficiency. Regional statistical differences in the prevalence of zinc deficiency in children were evident in the different groups. The zinc deficiency rate decreased significantly from 13.11% in the children with a family income lower than CNY 7500 group to 6.88% in the income greater than CNY 20,000 group. Except for the comparison of Zn deficiency between the family income less than CNY 7500 and CNY 7500 7500~<12,500 groups, there were significant differences between the other groups.

3.3. Multivariate Logistic Regression Model for Risk Factors Associated with Zn Deficiency in Chinese Children

An assessment of the potential risk factors associated with Zn deficiency is shown in Table 3. Among the classification variables, sex, anemia, nutritional status, city type and income were all associated with Zn deficiency. Compared with females, males had a higher risk of Zn deficiency, and the OR value for males was 1.552 (95% CI 1.410–1.709, p < 0.001). The OR value of Zn deficiency in people with anemia was 1.260 (95%CI 1.130–1.405, p < 0.001) compared with that of people without anemia. Compared with people in the city, the OR value of Zn deficiency in people who live in rural areas is 1.239 (95%CI 1.124–1.366, p < 0.001). In different the subgroup of nutritional status, the OR value, in comparison with normal people, was 1.443 for stunting (95%CI 1.190–1.750, p < 0.001), 0.881 for overweight (95%CI 0.808–0.960, p = 0.004), and 0.776 for obesity (95%CI 0.702–0.857, p < 0.001).

3.4. Association between Anemia and Zinc Deficiency in Different Groups

Based on the findings in Table 3, the relationship between anemia and zinc deficiency in different sexes and age groups is discussed in depth. The results are shown in Table 4. There was no statistical significance in the prevalence of zinc deficiency in different anemia states in age groups 6~<12 and 12~<18. There was also no significant difference in zinc deficiency under anemia conditions between the two age groups of the different genders assessed.

4. Discussion

Zinc deficiency has no characteristic signs or symptoms in metabolism or in clinic, but it can lead to widespread stunting and wasting [21]. Due to the low dietary consumption of the main sources of zinc, Asia and Africa have the highest prevalence of zinc deficiency in the global population at roughly 1 in 5 (17%) [22,23]. Estimates of child deaths due to zinc deficiency based on data from various studies range from 453,207 in the Global and Regional Child Mortality in 2004 [24] to 97,330 in the Global Burden of Disease System assessment in 2010 [25] to 116,000 in the Maternal and Child Nutrition Series in 2013 [12]. The prevalence of diseases caused by zinc deficiency is rising every year. According to studies, zinc deficiency in children is directly related to at least 50% of diarrhea-related deaths, 7% of pneumonia deaths, and 10% of malaria deaths [26]. The available data consistently show that zinc deficiency is a significant factor for population growth retardation in underdeveloped countries, even though growth retardation can occur in a variety of nutritional contexts [5]. However, clinical data in high-income environments show that infants with inadequate dietary zinc intake suffer delayed incremental growth [27]. In this study, we aimed to analyze the zinc nutritional status of children aged 6–18 in China using the latest national representative data.
Because zinc is found in the body’s numerous proteins and nucleic acids, it is difficult to measure an individual’s zinc nutritional status through laboratory tests [28]. The commonly used indicators for evaluating zinc nutritional status include serum zinc, urinary zinc, nail zinc and hair zinc [29]. It is found that serum zinc can assess the degree of risk of zinc deficiency in a specific population or subgroup by comparison [30]. A functional response to an intervention, such as growth in children or an immunological response, may be predicted using plasma zinc. With severe zinc depletion, there is a decrease in total body zinc that is reflected by the reduction in plasma zinc. In a meta-analysis of high-quality studies on the relationship between zinc consumption and plasma zinc, strong correlations were found in all groups [5]. Therefore, serum zinc is still used to evaluate the Zn nutritional status of Chinese children.
Due to the significant effect of zinc on the growth and development of young children, current studies on zinc deficiency mainly focus on children under 5 years old. There are few studies on children over 6 years old. The prevalence of zinc deficiency varies slightly by age. In this study, the median Zn concentration of 6–18 y children was 88.39 μg/dL, and the median serum zinc in the group containing children aged 6–12 years was 88 μg/dL, which was higher than the mean Zn concentrations, 62.7 μg/dL and 72.7 μg/dL of Thai 6–13-year-old children [31] Turkish 5–13-year-old children, respectively [32]. The prevalence of Zn deficiency in this study was 9.62%. According to IZiNCG recommendations, the entire population (or population sub-group) should be regarded as being at risk of zinc insufficiency if more than 20% of the population (or population sub-group) has a serum zinc concentration below the specified cutoff [18]. Based on this standard, the overall risk of zinc deficiency in children aged 6–18 in China is quiet low. However, when compared with the 7.9% Zn deficiency in Iranian 3–18 y children [33], the prevalence in China is still higher. In studies of zinc deficiency among females aged 12 to 49 in Mexico [34] and Ecuador [35], the prevalences were even much higher, at 28% and 56%, respectively, which were already meeting the criteria for deficiency in the population. Similarly, in a study of Turkish children aged 5–16, the prevalence of zinc deficiency was found to be 27.8%. Additionally, also in a national population based study in Mexican under-12-year-old children, the prevalence of Zn deficiency reached 25.3% [36]. Compared with the above studies, the zinc deficiency in Chinese children aged 6–18 was still at a low level.
In the analysis of Zn deficiency in subgroups, we found that the prevalence of Zn deficiency in males and females was significantly different. Additionally, males had a higher risk (OR = 1.552) of inadequate Zn levels when compared to females. Prior research that evaluated zinc deficiency rarely analyzed gender differences and most focused on female participants [37,38]. In this study, although the serum zinc level of girls is lower than that of boys, the zinc deficiency rate of boys is higher than that of girls. Some studies [39,40] report that a possible reason is the difference between eating habits. Since males consume more protein than females, the serum Zn concentration is much higher than for females. Zinc intake is closely related to protein intake [41]. However, the study of Pinna et al. [42] showed that the size of the exchangeable zinc pool in the human body positively correlated with the body weight removed from fat. Compared with men, women had lower body weight and body weight removed from fat, so the serum zinc concentration was also at a lower level. In this study, men had higher serum zinc concentrations than women, but also had a higher prevalence of zinc deficiency. This is mainly because the current criteria for zinc deficiency are 74 μg/dL for men and 70 μg/dL for women.
Additionally, because of this dietary factor, there a statistical difference in the prevalence of zinc deficiency under anemia. People with anemia had a higher prevalence of Zn deficiency, 10.88%, than those who do not have anemia, 9.54%. Meanwhile, in this study, the risk of zinc deficiency in anemic people is 1.26 times higher than that of non-anemic people. Iron and zinc are both essential micronutrients for human growth and health. Deficiencies in these nutrients are very common in the population. Cross-sectional studies showed that serum zinc levels were positively correlated with markers of hemoglobin and iron status [43]. Numerous human investigations have confirmed the link between low zinc and low hemoglobin [44,45], and animal research has shown that zinc is necessary for iron metabolism [46]. In a mechanism study, zinc has been shown to induce iron uptake and transcellular transport by inducing the expression of bivalent metal iron transporter-1 (DMT1) and ferritin (FPN1) [47,48], respectively. Motadi et al. [49] found that the proportion of iron deficiency accompanied by zinc deficiency in preschool children was 2%. Studies have reported that the zinc nutritional status of preschool children is an independent positive correlation factor with their hemoglobin level, and zinc deficiency can increase the risk of anemia in this population [50]. In two other studies, plasma zinc has been shown to be a strong predictor of hemoglobin and is independent of iron status [51]. Zinc may affect hemoglobin through several zinc-dependent enzyme systems involved in hemoglobin synthesis and erythrocyte production [51] Therefore, it is possible to utilize zinc as a sign of iron deficiency anemia [52]. According to our findings and the studies reported above, we conducted a stratified discussion on the two factors of anemia and zinc deficiency in this population. Unfortunately, no meaningful results were found. Our analysis may be due to the small sample size under the second stratification, which has a great impact on the statistical results. Therefore, the discussion was not continued. However, we will continue to explore the relationship between Zn deficiency and anemia.
At the same time, the prevalence of zinc deficiency for children under different nutritional conditions is also different. Children with stunting had the highest prevalence of zinc deficiency compared with other nutritional status. Additionally, stunting is one of the risk factors of zinc deficiency. According to reports, every year, 3 million children die from undernutrition-related causes, including fetal growth restriction, stunting, wasting, and vitamin A and zinc deficiencies [12]. Zinc deficiency is closely associated with stunting. Zinc deficiency can lead to growth retardation, which can also aggravate zinc deficiency. A study in Nepal found a strong correlation between zinc and children’s stunting. Zn supplementation can reduce children’s growth retardation by 1 to 7.5 percent [53]. Trials conducted in areas with high rates of stunting and/or wasting (such as Bangladesh [54,55] and India [56]) have also shown that zinc supplementation is beneficial for the entire study population. However, in this study, we also found that children with overweight and obesity have a lower risk of zinc deficiency than the normal group. A previous study analyzed the effects of zinc supplementation on insulin resistance and metabolic syndrome in obese children. Zinc supplementation is considered to be a useful and safe additional intervention [57]. However, the effectiveness of zinc supplements in treating obesity and diabetes has not been demonstrated in large-scale studies [58]. We consider that the difference in dietary intake may lead to more protein intake, which leads to higher zinc intake. However, the specific reasons need more research to be further understood.
The differences in zinc deficiency in city type, district and income may all be caused by different economic levels and environmental, economic, and lifestyle factors, including dietary models. However, in this study, we have no way to collect and analyze environmental factors. We hypothesize that the differences in economic level and dietary patterns in different regions may be responsible for the differences in zinc deficiency rates. Studies [32] have shown that the prevalence of zinc deficiency in children in developed countries is as low as 0–2% [59,60,61], while in developing countries it is as high as 13–55.7% [62,63]. It shows that economic level has a significant influence on zinc deficiency. The results of this study further confirm this conclusion. In this study, we found that children from families with an annual income of less than CNY 7500 had a higher risk of zinc deficiency compared with other groups. At the same time, we also found that children who live in rural areas have a higher prevalence of Zn deficiency and a higher risk of inadequate Zn reservation. This is consistent with the conclusion from a prior study—that is, poor dietary habits and nutritional status can seriously affect the vitamin and mineral levels of children in rural areas [32]. Although there were no significant differences in the risk of zinc deficiency among different districts, the prevalence of zinc deficiency in central and western regions is significantly higher than that in the economically developed eastern regions. Therefore, more attention should be paid to the zinc nutritional status of children from low-income families and rural areas.
Based on the national representative data, this study is the first to thoroughly assess the nutritional status of zinc in Chinese children aged 6 to 18 years old. We also, for the first time, assessed our children’s zinc deficiency and compared it with other countries. The potential causes of zinc deficiency were also investigated. The main limitations of this study are as follows: Firstly, we could not examine the level of dietary zinc consumption for this population. Therefore, no further analysis of the relationship between dietary zinc intake and serum zinc levels was possible. The second limitation involves the criteria for determining zinc deficiency in children. The widely used criteria for determining zinc deficiency in children are based on the NHANES II and IZiNCG. However, for children under 10 years old, there are only threshold values of Zn deficiency for morning (non-fasting) and afternoon (non-fasting). There is currently no internationally recognized or nationally representative standard for fasting serum zinc deficiency in children under 10 years of age. Due to this limitation, the standard of people over 10 years old was used uniformly for both children aged 6–10 and children aged 10 and above in this study. Thirdly, in this study, we did not detect the element iron. The screening criteria for anemia are indeed based on hemoglobin. The interaction between iron and zinc will be analyzed in the follow-up study. In future studies, we will first establish zinc deficiency evaluation criteria for children aged 6–10 years old based on data from the Chinese population, and verify the existing evaluation criteria for children over 10 years old in the Chinese population. At the same time, we will also test whether zinc deficiency increases the risk of anemia in the Chinese population, and explore the combined effects of zinc and iron.

5. Conclusions

Currently, there are not enough studies to fully assess children’s nutritional status for zinc, particularly those between the ages of 6 and 18. However, because zinc plays such a significant role in the entire process of growth and development in children, it is crucial to completely understand the zinc nutritional status and to provide zinc supplements in a timely manner. The 64,850 6–18-year-old Chinese children from CNNHS 2016–2017 had a median Zn concentration of 88.39 μg/dL. Additionally, the prevalence of Zn deficiency was 9.62%. According to the criteria of zinc deficiency in the population (less than 20%), zinc deficiency in children aged 6–18 in China is at a low level. Possible risk factors of Zn deficiency are being male, children with anemia, stunting and low family incomes, and children who live in rural areas. More attention needs to be paid to the zinc nutritional status of children in rural areas and with low income and malnourishment. A continuous follow-up for this population is also needed.
This study not only evaluated the zinc nutritional status of children in China, but also analyzed the possible influencing factors of zinc deficiency. It provides data support for better promotion of children’s health.

Author Contributions

Methodology, J.L.; software, W.C. and J.L.; investigation, S.J. and H.F.; resources, H.F. and D.Y.; writing—original draft preparation, H.Z. and J.L.; writing—review and editing, H.Z. and J.L.; supervision, L.Y.; funding acquisition, L.Y. All authors have read and agreed to the published version of the manuscript.

Funding

This study was funded by National financial projects: Assessment and application of nutrients requirement and food environment for Chinese residents (No. 131031107000210003).

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of China CDC (No.201614).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

All data for this article are from CNNHS 2016–2017 and specific data are not publicly available at this time.

Acknowledgments

We thank all the participants in our study and all the staff working for the China National Nutrition and Health Survey of Children and Lactating Mothers in 2016–2017 (CNNHS 2016–2017).

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Saper, R.B.; Rash, R. Zinc: An Essential Micronutrient. Am. Fam. Physician 2009, 79, 768. [Google Scholar] [PubMed]
  2. Granero, R.; Pardo-Garrido, A.; Carpio-Toro, I.L.; Ramírez-Coronel, A.A.; Martínez-Suárez, P.C.; Reivan-Ortiz, G.G. The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials. Nutrients 2021, 13, 4059. [Google Scholar] [CrossRef] [PubMed]
  3. World Health Organization. The World Health Report 2002—Reducing Risks, Promoting Healthy Life. Educ. Health Change Learn. Pract. 2003, 16, 230-230. [Google Scholar] [CrossRef]
  4. Prasad, A.S. Discovery of Human Zinc Deficiency and Studies in an Experimental Human Model. Am. J. Clin. Nutr. 1991, 53, 403–412. [Google Scholar] [CrossRef]
  5. King, J.C.; Brown, K.H.; Gibson, R.S.; Krebs, N.F.; Lowe, N.M.; Siekmann, J.H.; Raiten, D.J. Biomarkers of Nutrition for Development (BOND)-Zinc Review. J. Nutr. 2015, 146, 858S–885S. [Google Scholar] [CrossRef] [Green Version]
  6. Sandstead, H.H. Zinc Deficiency. A Public Health Problem? Am. J. Dis. Child. 1960 1991, 145, 853–859. [Google Scholar] [CrossRef] [PubMed]
  7. Read, S.A.; Obeid, S.; Ahlenstiel, C.; Ahlenstiel, G. The Role of Zinc in Antiviral Immunity. Adv. Nutr. 2019, 10, 696–710. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  8. MacDonald, R.S. The Role of Zinc in Growth and Cell Proliferation. J. Nutr. 2000, 130, 1500S–1508S. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  9. Prasad, A.S. Discovery of Human Zinc Deficiency: Its Impact on Human Health and Disease. Adv. Nutr. 2013, 4, 176–190. [Google Scholar] [CrossRef] [Green Version]
  10. Clegg, M.S.; Hanna, L.A.; Niles, B.J.; Momma, T.Y.; Keen, C.L. Zinc Deficiency-Induced Cell Death. IUBMB Life 2005, 57, 661–669. [Google Scholar] [CrossRef]
  11. Mayo-Wilson, E.; Imdad, A.; Junior, J.; Dean, S.; Bhutta, Z.A. Preventive Zinc Supplementation for Children, and the Effect of Additional Iron: A Systematic Review and Meta-Analysis. BMJ Open 2014, 4, e004647. [Google Scholar] [CrossRef] [PubMed]
  12. Black, R.E.; Victora, C.G.; Walker, S.P.; Bhutta, Z.A.; Christian, P.; de Onis, M.; Ezzati, M.; Grantham-McGregor, S.; Katz, J.; Martorell, R.; et al. Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Income Countries. Lancet Lond. Engl. 2013, 382, 427–451. [Google Scholar] [CrossRef] [PubMed]
  13. Ding, G. Tracking New Challenges of Nutrition Transition and Developing Specific Strategies to Promote Healthy China. China CDC Wkly. 2021, 3, 179–180. [Google Scholar] [CrossRef]
  14. Yu, D.; Zhao, L.; Zhang, J.; Yang, Z.; Yang, L.; Huang, J.; Fang, H.; Guo, Q.; Xu, X.; Ju, L.; et al. China Nutrition and Health Surveys (1982−2017). China CDC Wkly. 2021, 3, 193–195. [Google Scholar] [CrossRef] [PubMed]
  15. Shi, J.; He, L.; Yu, D.; Ju, L.; Guo, Q.; Piao, W.; Xu, X.; Zhao, L.; Yuan, X.; Cao, Q.; et al. Prevalence and Correlates of Metabolic Syndrome and Its Components in Chinese Children and Adolescents Aged 7–17: The China National Nutrition and Health Survey of Children and Lactating Mothers from 2016–2017. Nutrients 2022, 14, 3348. [Google Scholar] [CrossRef]
  16. WS/T 456—2014; Screening Standard for Malnutrition of School-Age Children and Adolescents. National Health Commission of People’s Republic of China: Beijing, China, 2014.
  17. WS/T 586—2018; Screening for Overweight and Obesity among School-Age Children and Adolescents. National Health Commission of People’s Republic of China: Beijing, China, 2018.
  18. International Zinc Nutrition Consultative Group. Assessing Population Zinc Status with Serum Zinc Concentrations. IZiNCG Technical Brief No. 02, 2nd ed.; International Zinc Nutrition Consultative Group: Oakland, CA, USA, 2012. [Google Scholar]
  19. Chang, L.; Liu, X.; Shi, H.; Dai, W.; Wang, H.; Jiang, Y. Association of 25-Hydroxyvitamin D with Hb and Lead in Children: A Chinese Population-Based Study. Public Health Nutr. 2014, 17, 827–832. [Google Scholar] [CrossRef] [Green Version]
  20. WST 441-2013; Method for Anemia Screen. National Health Commission of People’s Republic of China: Beijing, China, 2013.
  21. Hambidge, M. Human Zinc Deficiency. J. Nutr. 2000, 130, 1344S–1349S. [Google Scholar] [CrossRef] [Green Version]
  22. Liu, E.; Pimpin, L.; Shulkin, M.; Kranz, S.; Duggan, C.; Mozaffarian, D.; Fawzi, W. Effect of Zinc Supplementation on Growth Outcomes in Children under 5 Years of Age. Nutrients 2018, 10, 377. [Google Scholar] [CrossRef] [Green Version]
  23. Ahmed, T.; Hossain, M.; Sanin, K.I. Global Burden of Maternal and Child Undernutrition and Micronutrient Deficiencies. Ann. Nutr. Metab. 2012, 61 (Suppl. 1), 8–17. [Google Scholar] [CrossRef]
  24. Fischer Walker, C.L.; Ezzati, M.; Black, R.E. Global and Regional Child Mortality and Burden of Disease Attributable to Zinc Deficiency. Eur. J. Clin. Nutr. 2009, 63, 591–597. [Google Scholar] [CrossRef] [Green Version]
  25. Lim, S.S.; Vos, T.; Flaxman, A.D.; Danaei, G.; Shibuya, K.; Adair-Rohani, H.; Amann, M.; Anderson, H.R.; Andrews, K.G.; Aryee, M.; et al. A Comparative Risk Assessment of Burden of Disease and Injury Attributable to 67 Risk Factors and Risk Factor Clusters in 21 Regions, 1990–2010: A Systematic Analysis for the Global Burden of Disease Study 2010. Lancet Lond. Engl. 2012, 380, 2224–2260. [Google Scholar] [CrossRef] [Green Version]
  26. Raiten, D.J.; Sakr Ashour, F.A.; Ross, A.C.; Meydani, S.N.; Dawson, H.D.; Stephensen, C.B.; Brabin, B.J.; Suchdev, P.S.; van Ommen, B. INSPIRE Consultative Group Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE). J. Nutr. 2015, 145, 1039S–1108S. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  27. Krebs, N.F. Update on Zinc Deficiency and Excess in Clinical Pediatric Practice. Ann. Nutr. Metab. 2013, 62 (Suppl. 1), 19–29. [Google Scholar] [CrossRef]
  28. International Zinc Nutrition Consultative Group (IZiNCG); Brown, K.H.; Rivera, J.A.; Bhutta, Z.; Gibson, R.S.; King, J.C.; Lönnerdal, B.; Ruel, M.T.; Sandtröm, B.; Wasantwisut, E.; et al. International Zinc Nutrition Consultative Group (IZiNCG) Technical Document #1. Assessment of the Risk of Zinc Deficiency in Populations and Options for Its Control. Food Nutr. Bull. 2004, 25, S99–S203. [Google Scholar]
  29. International Zinc Nutrition Consultative Group. Assessing Population Zinc Exposure with Hair or Nail Zinc. IZiNCG Technical Brief No. 8; International Zinc Nutrition Consultative Group: Oakland, CA, USA, 2008. [Google Scholar]
  30. Davis: IZiNCG Quantifying the Risk of Zinc Deficiency: Recommended Indicators. Technical Brief No. 01. 2007. Available online: https://static1.squarespace.com/static/56424f6ce4b0552eb7fdc4e8/t/57493db901dbae66390e9dca/1464417728860/English_brief1.pdf (accessed on 7 February 2023).
  31. Thurlow, R.A.; Winichagoon, P.; Pongcharoen, T.; Gowachirapant, S.; Boonpraderm, A.; Manger, M.S.; Bailey, K.B.; Wasantwisut, E.; Gibson, R.S. Risk of Zinc, Iodine and Other Micronutrient Deficiencies among School Children in North East Thailand. Eur. J. Clin. Nutr. 2006, 60, 623–632. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  32. Vuralli, D.; Tumer, L.; Hasanoglu, A. Zinc Deficiency in the Pediatric Age Group Is Common but Underevaluated. World J. Pediatr. WJP 2017, 13, 360–366. [Google Scholar] [CrossRef] [PubMed]
  33. Gonoodi, K.; Moslem, A.; Darroudi, S.; Ahmadnezhad, M.; Mazloum, Z.; Tayefi, M.; Zadeh, S.A.T.; Eslami, S.; Shafiee, M.; Khashayarmanesh, Z.; et al. Serum and Dietary Zinc and Copper in Iranian Girls. Clin. Biochem. 2018, 54, 25–31. [Google Scholar] [CrossRef] [PubMed]
  34. Mejía-Rodríguez, F.; Shamah-Levy, T.; Villalpando, S.; García-Guerra, A.; Méndez-Gómez Humarán, I. Iron, Zinc, Copper and Magnesium Deficiencies in Mexican Adults from the National Health and Nutrition Survey 2006. Salud Publica Mex 2013, 55, 275–284. [Google Scholar] [CrossRef] [Green Version]
  35. Cediel, G.; Olivares, M.; Brito, A.; Cori, H.; López de Romaña, D. Zinc Deficiency in Latin America and the Caribbean. Food Nutr. Bull. 2015, 36 (Suppl. 2), S129–S138. [Google Scholar] [CrossRef] [Green Version]
  36. Villalpando, S.; García-Guerra, A.; Ramírez-Silva, C.I.; Mejía-Rodríguez, F.; Matute, G.; Shamah-Levy, T.; Rivera, J.A. Iron, Zinc and Iodide Status in Mexican Children under 12 Years and Women 12–49 Years of Age. A Probabilistic National Survey. Salud Publica Mex. 2003, 45 (Suppl. 4), S520–S529. [Google Scholar] [CrossRef] [Green Version]
  37. Schmidt, R.; Hiemisch, A.; Kiess, W.; von Klitzing, K.; Schlensog-Schuster, F.; Hilbert, A. Macro- and Micronutrient Intake in Children with Avoidant/Restrictive Food Intake Disorder. Nutrients 2021, 13, 400. [Google Scholar] [CrossRef] [PubMed]
  38. Walsh, K.; Blalock, D.V.; Mehler, P.S. Hematologic Findings in a Large Sample of Patients with Anorexia Nervosa and Bulimia Nervosa. Am. J. Hematol. 2020, 95, E98–E101. [Google Scholar] [CrossRef] [Green Version]
  39. Nagata, J.M.; Ganson, K.T.; Murray, S.B. Eating Disorders in Adolescent Boys and Young Men: An Update. Curr. Opin. Pediatr. 2020, 32, 476–481. [Google Scholar] [CrossRef] [PubMed]
  40. Murray, S.B.; Nagata, J.M.; Griffiths, S.; Calzo, J.P.; Brown, T.A.; Mitchison, D.; Blashill, A.J.; Mond, J.M. The Enigma of Male Eating Disorders: A Critical Review and Synthesis. Clin. Psychol. Rev. 2017, 57, 1–11. [Google Scholar] [CrossRef] [PubMed]
  41. Willoughby, J.L.; Bowen, C.N. Zinc Deficiency and Toxicity in Pediatric Practice. Curr. Opin. Pediatr. 2014, 26, 579–584. [Google Scholar] [CrossRef]
  42. Pinna, K.; Woodhouse, L.R.; Sutherland, B.; Shames, D.M.; King, J.C. Exchangeable Zinc Pool Masses and Turnover Are Maintained in Healthy Men with Low Zinc Intakes. J. Nutr. 2001, 131, 2288–2294. [Google Scholar] [CrossRef] [Green Version]
  43. Kondaiah, P.; Yaduvanshi, P.S.; Sharp, P.A.; Pullakhandam, R. Iron and Zinc Homeostasis and Interactions: Does Enteric Zinc Excretion Cross-Talk with Intestinal Iron Absorption? Nutrients 2019, 11, 1885. [Google Scholar] [CrossRef] [Green Version]
  44. Ma, A.-G.; Chen, X.-C.; Xu, R.-X.; Zheng, M.-C.; Wang, Y.; Li, J.-S. Comparison of Serum Levels of Iron, Zinc and Copper in Anaemic and Non-Anaemic Pregnant Women in China. Asia Pac. J. Clin. Nutr. 2004, 13, 348–352. [Google Scholar]
  45. Ergul, A.B.; Turanoglu, C.; Karakukcu, C.; Karaman, S.; Torun, Y.A. Increased Iron Deficiency and Iron Deficiency Anemia in Children with Zinc Deficiency. Eurasian J. Med. 2018, 50, 34–37. [Google Scholar] [CrossRef] [Green Version]
  46. Chen, Y.-H.; Feng, H.-L.; Jeng, S.-S. Zinc Supplementation Stimulates Red Blood Cell Formation in Rats. Int. J. Mol. Sci. 2018, 19, 2824. [Google Scholar] [CrossRef] [Green Version]
  47. Iyengar, V.; Pullakhandam, R.; Nair, K.M. Coordinate Expression and Localization of Iron and Zinc Transporters Explain Iron-Zinc Interactions during Uptake in Caco-2 Cells: Implications for Iron Uptake at the Enterocyte. J. Nutr. Biochem. 2012, 23, 1146–1154. [Google Scholar] [CrossRef] [PubMed]
  48. Troadec, M.B.; Ward, D.M.; Lo, E.; Kaplan, J.; De Domenico, I. Induction of FPN1 Transcription by MTF-1 Reveals a Role for Ferroportin in Transition Metal Efflux. Blood 2010, 116, 4657–4664. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  49. Motadi, S.A.; Mbhenyane, X.G.; Mbhatsani, H.V.; Mabapa, N.S.; Mamabolo, R.L. Prevalence of Iron and Zinc Deficiencies among Preschool Children Ages 3 to 5 y in Vhembe District, Limpopo Province, South Africa. Nutrition 2015, 31, 452–458. [Google Scholar] [CrossRef] [PubMed]
  50. Greffeuille, V.; Fortin, S.; Gibson, R.; Rohner, F.; Williams, A.; Young, M.F.; Houghton, L.; Ou, J.; Dijkhuizen, M.A.; Wirth, J.P.; et al. Associations between Zinc and Hemoglobin Concentrations in Preschool Children and Women of Reproductive Age: An Analysis of Representative Survey Data from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project. J. Nutr. 2021, 151, 1277–1285. [Google Scholar] [CrossRef] [PubMed]
  51. Gibson, R.S.; Abebe, Y.; Stabler, S.; Allen, R.H.; Westcott, J.E.; Stoecker, B.J.; Krebs, N.F.; Hambidge, K.M. Zinc, Gravida, Infection, and Iron, but Not Vitamin B-12 or Folate Status, Predict Hemoglobin during Pregnancy in Southern Ethiopia. J. Nutr. 2008, 138, 581–586. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  52. Nagata, J.M.; Bojorquez-Ramirez, P.; Nguyen, A.; Ganson, K.T.; McDonald, C.M.; Machen, V.I.; Downey, A.; Buckelew, S.M.; Garber, A.K. Sex Differences and Associations between Zinc Deficiency and Anemia among Hospitalized Adolescents and Young Adults with Eating Disorders. Eat. Weight Disord. EWD 2022, 27, 2911–2917. [Google Scholar] [CrossRef] [PubMed]
  53. Bevis, L.; Kim, K.; Guerena, D. Soil Zinc Deficiency and Child Stunting: Evidence from Nepal. J. Health Econ. 2023, 87, 102691. [Google Scholar] [CrossRef]
  54. Larson, C.P.; Nasrin, D.; Saha, A.; Chowdhury, M.I.; Qadri, F. The Added Benefit of Zinc Supplementation after Zinc Treatment of Acute Childhood Diarrhoea: A Randomized, Double-Blind Field Trial. Trop. Med. Int. Health 2010, 15, 754–761. [Google Scholar] [CrossRef] [Green Version]
  55. Chang, S.; El Arifeen, S.; Bari, S.; Wahed, M.A.; Rahman, K.M.; Rahman, M.T.; Mahmud, A.B.A.; Begum, N.; Zaman, K.; Baqui, A.H.; et al. Supplementing Iron and Zinc: Double Blind, Randomized Evaluation of Separate or Combined Delivery. Eur. J. Clin. Nutr. 2010, 64, 153–160. [Google Scholar] [CrossRef]
  56. Bhandari, N.; Bahl, R.; Taneja, S.; Strand, T.; Mølbak, K.; Ulvik, R.J.; Sommerfelt, H.; Bhan, M.K. Substantial Reduction in Severe Diarrheal Morbidity by Daily Zinc Supplementation in Young North Indian Children. Pediatrics 2002, 109, e86. [Google Scholar] [CrossRef] [Green Version]
  57. Hashemipour, M.; Kelishadi, R.; Shapouri, J.; Sarrafzadegan, N.; Amini, M.; Tavakoli, N.; Movahedian-Attar, A.; Mirmoghtadaee, P.; Poursafa, P. Effect of Zinc Supplementation on Insulin Resistance and Components of the Metabolic Syndrome in Prepubertal Obese Children. Horm. Athens Greece 2009, 8, 279–285. [Google Scholar] [CrossRef]
  58. Fukunaka, A.; Fujitani, Y. Role of Zinc Homeostasis in the Pathogenesis of Diabetes and Obesity. Int. J. Mol. Sci. 2018, 19, 476. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  59. Karr, M.; Mira, M.; Causer, J.; Earl, J.; Alperstein, G.; Wood, F.; Fett, M.J.; Coakley, J. Plasma and Serum Micronutrient Concentrations in Preschool Children. Acta Paediatr. 1997, 86, 677–682. [Google Scholar] [CrossRef] [PubMed]
  60. Thane, C.W.; Bates, C.J.; Prentice, A. Zinc and Vitamin A Intake and Status in a National Sample of British Young People Aged 4-18 y. Eur. J. Clin. Nutr. 2004, 58, 363–375. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  61. Laitinen, R.; Vuori, E.; Dahlström, S.; Akerblom, H.K. Zinc, Copper, and Growth Status in Children and Adolescents. Pediatr. Res. 1989, 25, 323–326. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  62. Al-Timimi, D.J.; Al-Sharbatti, S.S.; Al-Najjar, F. Zinc Deficiency among a Healthy Population in Baghdad, Iraq. Saudi Med. J. 2005, 26, 1777–1781. [Google Scholar]
  63. Duque, X.; Flores-Hernández, S.; Flores-Huerta, S.; Méndez-Ramírez, I.; Muñoz, S.; Turnbull, B.; Martínez-Andrade, G.; Ramos, R.I.; González-Unzaga, M.; Mendoza, M.E.; et al. Prevalence of Anemia and Deficiency of Iron, Folic Acid, and Zinc in Children Younger than 2 Years of Age Who Use the Health Services Provided by the Mexican Social Security Institute. BMC Public Health 2007, 7, 345. [Google Scholar] [CrossRef] [Green Version]
Table
Table 1. Serum zinc levels of Chinese children under different stratified factors.
Table 1. Serum zinc levels of Chinese children under different stratified factors.
IndexesN (%)Zinc Concentrationχ2p
Median (μg/dL)Q25~Q75 (μg/dL)
Total64,850 (100%)88.3980.00~98.80
Sex 174.16<0.001
Male32,384 (49.94%)89.0080.30~99.60
Female32,466 (50.06%)88.0079.00~97.80
Age group 7.130.008
6~<1236,065 (55.61%)88.0080.00~98.20
12~<1828,785 (44.39%)89.0080.00~99.00
Anemia 77.59<0.001
Yes3285 (5.07%)86.4078.00~96.00
No61,565 (94.93%)88.8480.00~99.00
Nutritional status 264.32<0.001
Stunting890 (1.37%)86.00 a77.00~96.00
Wasting5681 (8.76%)88.00 b80.00~98.00
Normal45,130 (69.59%)88.00 b79.00~98.00
Overweight7258 (11.19%)90.00 c81.00~100.00
Obesity5885 (9.07%)91.00 d82.00~101.00
City type 299.18<0.001
City31,300 (48.27%)89.7081.00~99.00
Rural33,550 (51.73%)87.3078.90~98.00
District 1475.58<0.001
Eastern23,510 (36.25%)90.59 a82.00~100.60
Central19,461 (30.01%)89.10 b79.86~101.80
Western21,879 (33.70%)86.00 c78.00~94.00
Income (yuan) 153.19<0.001
<75005115 (7.89%)86.00 a78.00~96.00
7500~<12,5005522 (8.52%)87.00 a78.00~96.00
12,500~<20,0005053 (7.79%)87.68 b79.00~97.00
>20,0006222 (9.59%)89.00 c81.00~99.00
a,b,c,d: The comparison of differences between groups; the same letter has no difference, different letters have differences.
Table
Table 2. The prevalence of zinc deficiency in Chinese 6–18-year-old children.
Table 2. The prevalence of zinc deficiency in Chinese 6–18-year-old children.
IndexesNZinc Deficiencyχ2p
nPrevalence (%)95%CI
Total64,85063209.629.22~10.00
Sex 68.26<0.001
Male32,384379511.1410.56~11.72
Female32,46625257.867.35~8.37
Age group 15.77<0.001
6~<1236,065363810.449.85~11.02
12~<1828,78526828.858.33~9.38
Anemia 17.28<0.001
Yes328538910.889.17~12.59
No61,56559319.549.14~9.94
Nutritional status 3.980.003
Stunting89012313.55 a10.39~16.71
Wasting56815689.11 b7.79~10.44
Normal45,13045149.88 b9.40~10.35
Overweight72586478.94 c7.85~10.03
Obesity58854678.02 c6.84~9.20
City type 47.27<0.001
City31,30026348.207.69~8.71
Rural33,550368610.9210.34~11.51
District 112.87<0.001
Eastern23,51016836.15 a5.60~6.70
Central19,461225012.36 b11.62~13.11
Western21,879238712.12 b11.34~12.89
Income (yuan) 15.33<0.001
<7500511558013.11 a11.44~14.78
7500~<12,500552263110.69 a9.21~12.17
12,500~<20,00050535058.64 b7.29~9.99
>20,00062225436.88 c5.88~7.89
a,b,c: Horizontal comparison of differences between groups, The same letter has no difference; different letters have differences.
Table
Table 3. Multivariate logistic regression model for risk factors associated with Zn deficiency.
Table 3. Multivariate logistic regression model for risk factors associated with Zn deficiency.
IndexesOR95%CIp
SexFemale---
Male1.5521.410~1.709<0.001
Age group12~<18---
6~<121.0680.974~1.1710.159
AnemiaNo---
Yes1.2601.130~1.405<0.001
Nutritional statusNormal---
Stunting1.4431.190~1.750<0.001
Wasting1.0000.912~1.0960.992
Overweight0.8810.808~0.9600.004
Obesity0.7760.702~0.857<0.001
City typeCity---
Rural1.2391.124~1.366<0.001
DistrictEastern---
Central1.0900.971~1.2240.304
Western1.0790.964~1.2070.478
Income (yuan)>20,000---
<75001.2611.095~1.4530.017
7500~<12,5001.2241.069~1.4010.079
12,500~<20,0001.0960.952~1.2610.353
Table
Table 4. Association between anemia and zinc deficiency in different age groups.
Table 4. Association between anemia and zinc deficiency in different age groups.
IndexesNZinc Deficiencyχ2p
nPrevalence (%)95%CI
Total 64,85063209.629.22~10.00
Sex 68.26<0.001
Male 32,384379511.1410.56~11.72
Female 32,46625257.867.35~8.37
Age groupAnemia36,0653638 3.540.06
6~<12Yes141918413.0110.00~16.02
No34,646345410.339.73~10.92
Anemia28,7852682 0.590.44
12~<18Yes18662059.607.56~11.65
No26,91924778.808.26~9.34
Sex groupAnemia 2.540.11
MaleYes115616111.0610.47~11.65
No31,228363413.4910.31~16.68
Anemia 3.000.08
FemaleYes21292289.417.44~11.39
No30,33722977.747.21~8.27
MaleAnemia17,969 2.730.10
6~<12Yes68510112.2711.39~13.15
No17,284214815.9811.19~20.78
Anemia14,415 0.020.89
12~<18Yes4716010.186.58~13.78
No13,94414869.929.13~10.71
FemaleAnemia18,096 0.820.37
6~<12Yes734839.426.33~12.52
No17,36213068.047.27~8.81
Anemia14,370 2.690.10
12~<18Yes13951459.416.97~11.86
No12,9759917.466.73~8.18
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Lu, J.; Zhang, H.; Cao, W.; Jiang, S.; Fang, H.; Yu, D.; Yang, L. Study on the Zinc Nutritional Status and Risk Factors of Chinese 6–18-Year-Old Children. Nutrients 2023, 15, 1685. https://doi.org/10.3390/nu15071685

AMA Style

Lu J, Zhang H, Cao W, Jiang S, Fang H, Yu D, Yang L. Study on the Zinc Nutritional Status and Risk Factors of Chinese 6–18-Year-Old Children. Nutrients. 2023; 15(7):1685. https://doi.org/10.3390/nu15071685

Chicago/Turabian Style

Lu, Jiaxi, Huidi Zhang, Wei Cao, Shan Jiang, Hongyun Fang, Dongmei Yu, and Lichen Yang. 2023. "Study on the Zinc Nutritional Status and Risk Factors of Chinese 6–18-Year-Old Children" Nutrients 15, no. 7: 1685. https://doi.org/10.3390/nu15071685

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop