Anemia affects a significant portion of the population, and zinc deficiency may contribute to its pathogenesis. This study examined the impact of zinc supplementation on hemoglobin and zinc levels across high-risk subgroups. We conducted a retrospective study of adults ≥ 18 years with chronic anemia and zinc deficiency who received daily zinc sulfate 220 mg. Hemoglobin and plasma zinc were recorded at 3, 6, and 12 months. Subgroups included patients stratified by CKD, BMI, PPI use, age > 70, poly-micronutrient deficiency, and malnutrition or prior bowel resection. Among 125 patients (median age 68), mean hemoglobin increased from 9.8 g/dL to 11.4 g/dL by 12 months (p=0.000022), with corresponding increases in zinc levels. Anemia resolved in 42% of patients. Zinc deficiency resolved in 63.8%. Those with CKD, malnutrition, prior bariatric surgery, or PPI use showed significant hemoglobin improvement after zinc replacement and PPI discontinuation. No statistically significant differences in response were observed by BMI. Zinc supplementation improved hemoglobin across multiple high-risk groups, suggesting an independent role of zinc in erythropoiesis. Limitations include the retrospective design, concurrent treatment of comorbidities including hematologic malignancies, and non-uniform monitoring of inflammatory markers. Zinc deficiency is an independent and reversible contributor to anemia. Screening and supplementation will need to be studied in a prospective trial to clarify the clinical significance of zinc deficiency in chronic and otherwise unexplained anemia, particularly among those with CKD, advanced age, malnutrition, prior bowel resection, and PPI use.
Hagele et al. (Sun,) studied this question.