The Copper/Zinc Ratio Correlates With Markers of Disease Activity in Patients With Inflammatory Bowel Disease. Original paper

What was studied?

This study examines the relationship between zinc (Zn) and copper (Cu) concentrations, particularly the Cu/Zn ratio, and markers of disease activity in patients with inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). Zinc and copper are trace elements essential for immune function and antioxidant processes. The study explores how these elements, along with the Cu/Zn ratio, correlate with clinical markers of inflammation, such as C-reactive protein (CRP) and fecal calprotectin (FC), in patients with active IBD. This correlation could provide insights into the potential role of these trace elements in disease progression and activity.

Who was studied?

The study involved 154 IBD patients (98 with CD and 56 with UC), who were recruited from a gastroenterology department in Basel, Switzerland. Participants were in various stages of disease activity, with a majority of CD patients in clinical remission. Disease activity was assessed using the Harvey–Bradshaw Index (HBI) for CD and the Modified Truelove and Witts Severity Index (MTWSI) for UC. The patients’ zinc and copper levels were measured alongside inflammatory markers (CRP and FC), and their relationship was analyzed through multiple linear regression models, adjusting for confounding factors like age and gender.

Most important findings

The study found that zinc insufficiency was present in 11.2% of CD patients and 14.3% of UC patients. Copper insufficiency was observed in 20.4% of CD patients and 7.1% of UC patients. Zinc deficiency in IBD patients was associated with anemia, hypoalbuminemia, and elevated levels of both CRP and FC, indicating an active inflammatory state. On the other hand, copper deficiency was linked to lower CRP values and a trend toward lower FC in both CD and UC patients. The key finding was that the Cu/Zn ratio correlated significantly with disease activity markers: the Cu/Zn ratio was positively associated with CRP levels in both CD and UC patients, and with FC levels specifically in UC patients. The study also found that adjusting for serum albumin did not significantly affect the correlation between Cu/Zn ratio and CRP, suggesting that the Cu/Zn ratio could be a reliable marker for systemic inflammation in IBD patients.

Key implications

These findings suggest that the Cu/Zn ratio may serve as a novel biomarker for assessing disease activity in IBD patients. The significant correlation between the Cu/Zn ratio and inflammatory markers like CRP and FC points to the potential utility of this ratio in clinical settings, offering a non-invasive way to monitor disease progression. Given the elevated Cu/Zn ratio observed in active disease states, monitoring these trace elements could improve the management of IBD, allowing for better-informed treatment decisions, particularly in cases where traditional markers of inflammation may not provide a full picture. Additionally, the study highlights the importance of addressing micronutrient deficiencies in IBD patients, as deficiencies in zinc and copper may contribute to disease severity and complications. Further prospective studies are needed to validate the Cu/Zn ratio as a diagnostic and prognostic tool in IBD, and to explore the potential benefits of zinc and copper supplementation as part of IBD management.