Download Zinc, copper and magnesium intake in a daily diet in opiate‑addicted

Kolarzyk
Probl
HigEEpidemiol
i wsp. Zinc,
2010,
copper
91(2):
and243-247
magnesium intake in a daily diet in opiate-addicted persons before and after ...
243
Zinc, copper and magnesium intake in a daily diet
in opiate‑addicted persons before and after 5 years
of methadone treatment
Podaż cynku, miedzi i magnezu w diecie osób uzależnionych od opiatów przed rozpoczęciem
oraz po 5 latach trwania leczenia substytucyjnego metadonem
Emilia Kolarzyk 1/, Agnieszka Szpanowska-Wohn 1/, Jan Chrostek-Maj 2/
1/
2/
Department of Hygiene and Ecology, Jagiellonian University, Medical College, Krakow
Rydygier Hospital, Center for Dependency Treatment, Krakow
Cel pracy. Oszacowanie podaży cynku, miedzi i magnezu w diecie osób
uzależnionych od opiatów przed rozpoczęciem oraz po 5 latach trwania
leczenia substytucyjnego metadonem.
Aim. Estimation of zinc, copper and magnesium intake in the diet of opiateaddicted persons before and after 5 years of methadone maintenance
treatment.
Materiał i metoda. Badaniami objęto 35 uzależnionych osób (12 kobiet
i 35 mężczyzn). Sposób żywienia, z uwzględnieniem podaży cynku, miedzi
i magnezu, był oceniany metodą 24-godzinnego wywiadu. Uzyskane
wyniki były odnoszone do norm żywieniowych na bezpiecznym poziomie
spożycia.
Material & method. Thirty five opiate-addicted persons were included in
the examination (12 women and 23 men). The nutritional model including
zinc, copper and magnesium intake estimation was analysed on the basis
of a 24-hour nutritional recall. The received values were compared with
the daily norms of the safe intake level.
Wyniki. W badaniu wyjściowym średnia podaż wszystkich ocenianych
mikroelementów była niższa niż rekomendowana, zarówno w grupie
mężczyzn (59,0-71,5%) jak i w grupie kobiet (43,0-782%). Po 5 latach
leczenia substytucyjnego metadonem magnez i cynk był spożywany
w zalecanych ilościach przez kobiety, natomiast w grupie mężczyzn spożycie
magnezu, cynku i miedzi nie uległo istotnej zmianie i wciąż było niższe
niż zalecany poziom.
Results. In the initial examination the mean intake of all analyzed
microelements in a daily diet was lower than the recommended both in
men (59.0-71.5%) and in women (43.0-78.2%) groups. After 5 years of
methadone maintenance treatment in the group of examined women,
magnesium and zinc were consumed according to the recommended
values. In the men’s group the magnesium, zinc and copper consumption
did not change and was still lower than the safe consumption level.
Wnioski. Badania wykazały nieprawidłowe zachowania żywieniowe osób
uzależnionych i były podstawą do podjęcia wysiłków w celu zmotywowania
badanych do przestrzegania zaleceń żywieniowych, obejmujących
również podaż mikroelementów. Powyższe badania były tylko jednym
z elementów wielokierunkowej opieki mającej na celu pomóc osobom
uzależnionym w powrocie do zdrowia, w aspekcie zarówno fizycznym jak
i psychicznym.
Conclusions. The quoted results of our examination showed incorrect
nutritional behaviors and were the reason to motivate addicted patients to
respect recommendations concerning the microelements consumption. The
research was one of the elements of multidimensional care over addicted
persons, aimed to help addicted people in recovering and improving their
physical and mental health.
Słowa kluczowe: cynk, miedź, magnez, 24-godzinny wywiad żywieniowy,
uzależnienie od opiatów, program metadonowy
© Probl Hig Epidemiol 2010, 91(2): 243-247
www.phie.pl
Nadesłano: 10.03.2009
Zakwalifikowano do druku: 17.05.2010
Introduction
The opiate addiction is a severe, chronic disease
of central nervous system and addicted persons
are the group of patients who may develop, more
frequently than others, such diseases as: dermatitis,
phlebitis (followed by clots in venal system), hepatitis,
pancreatitis, osteitis, and in some cases sepsis. The
Key words: magnesium, zinc, copper, 24-hour nutritional recall, opiate
dependence, methadone program.
Adres do korespondencji / Address for correspondence
Prof. dr hab. Emilia Kolarzyk
Department of Hygiene and Ecology, Jagiellonian University, Medical
College, Krakow, 7 Kopernik Street, Krakow, Poland
tel./fax +48-12-422-37-20, e-mail: [email protected]
drug-addicts are the persons from the risk groups
of AIDS and sexually transmitted diseases. The
treatment of addicted persons is very difficult because
the drug addiction is connected with neurobiological
mechanisms and depends on some psychological,
social and economic factors [1,2].
Presently, an important way of help for
opiate- (morphine-, heroin-) addicted persons are
244
substitutional programs. The most helpful drug
used in long-term treatment of opiate-addiction is
methadone [3,4].
Methadone is a synthetic agonist of opioid
receptors. It may be administered orally and it is active
in organisms for 24 hours. Since January 2000 the
methadone therapy for opiate-addicted persons has
started in Krakow. Interprofessional collaboration
between different specialists is realized – the patients
are given the complex psychological, psychiatric and
medical care [5]. A lot of attention is being paid to
their consumption pattern, their nutritional status
and dietetic recommendations. It is very important for
addicted persons because a well-balanced diet in the
aspect of main nutritional products (carbohydrates,
proteins and fats) and a proper intake of vitamins and
microelements may effectively support the medical
treatment [6,7].
The research data show that such microelements
as zinc, copper and magnesium play a role in the
normalization of physiological and biochemical
functions that had changed because of used drugs
[2]. Currently some investigators have been reporting
a change in serum trace element contents in drugaddicted individuals and the different levels of
these elements in the blood of addicted persons in
comparison with healthy people were shown [8,9,10].
Nevertheless the estimation of the intake of zinc,
copper and magnesium in the diet of addicted persons
treated for a long time with methadone has not yet
been performed.
Aim
Estimation of the intake of zinc, copper and
magnesium in the diet of opiate-addicted persons
before and after 5 years of methadone maintenance
treatment.
Materials and Methods
The studied group included 35 persons (12
women and 23 men) treated with methadone
continuously for at least 5 years. All of them used the
so-called „kompot” (literally this Polish word could
be translated as English “compote”– stewed fruits),
“Polish heroin” (heroin, morphine, codeine in small
amounts, and some amount of 6-monoacetylmo,
morphine) [11] parenterally, and some of them also
used amphetamine, THS, LSD or benzodiazepines
orally. An individual oral methadone dose adequate
for blocking the drug craving and hunger was
established for each patient. An adequate effective
dose of methadone was administrated daily and serum
methadone concentration was monitored. Urine
samples were taken regularly to control the patients’
abstinence from opiates [12].
Probl Hig Epidemiol 2010, 91(2): 243-247
The nutritional model of addicted persons was
assessed by the specialists from the Department of
Hygiene and Ecology, Medical College of Jagiellonian
University, Krakow, on the basis of a 24-hour
nutritional recall. The nutritional recall was performed
twice: just before the treatment was started (the initial
examination – Exam 1) and after 5 years of methadone
maintenance treatment (the final examination
– Exam 2). The nutritional recall was performed during
3 non-consecutive days for every person both in the
initial and in the final examination. The “Album of
products and meal portions” was used in the recall.
The obtained quantitative nutritional analyses were
processed with the use of specialized nutrition software
calculating nutritional values of a daily diet.
In the present study the analysis concerned the
main nutritional components (proteins, fats and
carbohydrates) and such microelements as: zinc,
copper and magnesium. The received data were set
against the consumption standards for the Polish
population on the safe intake level (N) [13]. The
normal range was established at ±10% of the safe level
(N±10%).
The statistical significance of differences between
the results obtained in particular examinations were
calculated by the Mann-Whitney U test.
All subjects gave informed consent prior to their
recruitment in the study. The Ethics Committee for
Human Research of Jagiellonian University, Medical
College approved the study.
Results
The length of the period of opiate addiction,
age, gender, body mass, body height and BMI values
for all examined men and women were presented in
particular examinations in Tab. I.
Table I. General and anthropometric characteristics of drug-addicted women
and men in the initial (1) and final (2) examinations
Women (N=12)
Variable
Duration of opiateaddiction [exam.1]
(years)
Men (N=23)
X
SD
Min
Max
X
SD
Min
Max
8.8
3.5
5.0
15.0
12.0
5.8
6.0
28.0
Age at the initial
exam [years]
27.4* 5.8 21.0
37.0 30.4* 5.1 25.0
45.0
Age at the final
exam [years]
33.2 5.9 25.0
40.0
49.0
Height [cm]
168.7 6.1 160.0 177.0 177.8 6.2 163.0 190.0
Body weight 1[kg]
57.7 4.9 54.0
66.0 73.7* 16.9 51.0 136.0
Body weight 2 [kg]
56.0 9.1 50.0
76.0
BMI 1 [ kg/m2 ]
20.3 1.5 17.6
22.6 23.3* 5.3 17.1
44.9
BMI 2 [ kg/m2 ]
19.8 2.7 17.2
25.4
55.1
X – arithmetic mean
SD – standard deviation
* p – 1:2 < 0.05
36.3
6.2 30.0
82.5 25.0 60.0 145.0
25.9
7.9 19.0
Kolarzyk E i wsp. Zinc, copper and magnesium intake in a daily diet in opiate-addicted persons before and after ...
Statistically significant elevation in body
weight and BMI values of males were noted in
the final examination in comparison to the initial
examination.
Figure 1 shows the basic nutritional components
intake in the diet of examined persons expressed as the
percentage participation of these components in the
energy intake in a daily nutritional ratio (DNR).
245
In the initial examination it was found that
average intake of all 3 analyzed minerals in DNR
was lower than the recommended intake on the safe
level: 59.0% – Cu, 69.1% – Zn, 71.5% – Mg in men
group and 43.0 – Cu, 76.2% – Zn, 74.2% – Mg in the
women’s group (Fig. 2) .
Copper
Zinc
Magnesium
110
Safe level (±10%)
100%
90
90%
80%
70%
35,16
45
%
60%
50%
36,58
10
20,13
16,48
30
28,31
31,54
15
13,90
14,51
Norm
Exam. I
Exam. II
40%
30%
20%
10%
0%
Men
Women
Men
Exam. I
Women
Men
Women
Exam. II
Fig. 2. The daily intake of copper, zinc and magnesium in relation to
normal range (±10% of the safe level)
% E from polysaccharides
% E from mono- and disaccharides
% E from fat
% E from proteins
Fig. 1. The contribution of different nutrients in the energy intake in
comparison to recommendations
The daily diet of an adult is considered adequate
when proteins provide 10-15% of whole energy intake,
fats – maximum 30%, carbohydrates about 55-60%,
but monosaccharides no more than 10% of energy. In
the diet of examined persons, these proportions were
distorted. The contribution of proteins in the energy
intake was too low, mainly in the initial examination
(13.5%) of the daily intake of energy, whereas in the
final examination fats provided slightly more energy.
Monosaccharide provided much more than the
recommended ratio – 20.1% in the initial examination
and 16.5% in the final examination. Fats provided
slightly more energy than the recommended 30% of
energy expenditure in the final examination.
After 5 years of the substitution treatment with
methadone a statistically insignificant increase of zinc
and copper and a statistically significant increase of
magnesium intake was found in the examined women
(Table II). Despite of that increase, the level of copper
intake was still below the lower limit of the safety level
(62.5 %) but zinc and magnesium were consumed on
a little higher level than the upper safe level (N+10%)
amounts (111.0% and 112.9%) (Fig. 2).
In the men’s group the increase of intake
(insignificant) was observed for magnesium. The
zinc intake was the same and the copper intake was
slightly lower (Table II). The consumption of all 3
elements was lower than the safety level. The norm
realization was 53.5% (copper), 67.8% (zinc) and
78.9% (magnesium) (Fig. 2).
Table II. Statistical characteristics of the mineral content in a daily diet in women and men in the initial (exam. 1) and final examinations (exam. 2)
Minerals
Women (N=12)
Men (N=23)
X
SD
Med
Min
Max
p
X
SD
Med
Min
Max
p
Copper 1 [mg]
0.9
0.4
0.9
0.3
1.4
ns
1.2
0.7
1.3
0.0
3.1
ns
Copper 2
1.3
0.9
1.4
0.2
3.0
Zinc 1 [mg]
7.9
3.1
8.3
4.1
12.3
Zinc 2
11.1
6.4
11.3
2.0
20.8
Magnesium 1 [mg]
207.8
63.8
199.1
103.2
310.6
Magnesium 2
316.0
89.5
328.5
183.9
349.1
X – arithmetic mean
SD – standard deviation
Med – median
P – 1:2 (U-test )
ns – not statistically significant
1.1
0.6
1.2
0.2
3.0
ns
9.5
4.9
8.9
0.0
22.1
9.5
4.1
9.4
2.9
19.6
0.05
250.5
85.0
244.2
47.0
317.8
276.3
75.8
257.4
84.0
367.3
ns
ns
246
Discussion
The change of the diet during the 5-year period of
methadone maintenance treatment may be influenced
by many factors: socio-economical factors, health
status, change of food preferences, natural senescence
and many others. As mentioned in the introduction,
the data concerning the control of carbohydrates,
proteins, fats, vitamin and mineral intake in the diet
in the aspect of the long-lasting methadone treatment
were not found.
As far as microelements such as zinc, copper and
magnesium, the results of this study indicate that
before the methadone treatment the mean intake of
all 3 analyzed elements in a daily nutritional ratio was
lower than the recommended safe level both in men
and in women. After 5 years of methadone therapy
in the group of examined women the consumption
of magnesium and zinc was even higher than the
recommended values, however in the men’s group,
the magnesium, zinc and copper consumption still
was lower than the safe consumption level.
The zinc, copper and magnesium shortages
in a daily diet before the methadone treatment
(duration of opiate-addiction: 8.8+3.5 years) were
not corresponding with the described by other authors
concentrations of these elements in blood or urine of
opiate-addicted persons [9], and showed an increased
blood concentration of copper and a decreased level
of zinc in heroin-addicted persons in comparison
to healthy people. The examinations conducted by
Iyengar at al. [8] showed an increased excretion of zinc
and copper with urine in comparison to the control
group, however this excretion was still within normal
values.
Previous research conducted in Poland did not
give unequivocal results in the range of the selected
elements concentrations in serum of drug-addicts
[14], observed higher mean concentrations of
magnesium in the addicted group [14], showed that
using opioids for a long time may be connected with
the decrease of magnesium concentration in blood
serum and that the interrelations between magnesium
concentration in blood serum, HIV infection and
methadone treatment were not found.
The examinations conducted in The Clinic
of Toxicology, Jagiellonian University Collegium
Medicum in Krakow, Poland [15,16] showed that
before starting the treatment in the Detoxification
Department the average concentration of zinc in the
blood of addicted people was lower, of copper – higher,
and of magnesium – similar to concentrations of these
elements in the control group. After the detoxification
Probl Hig Epidemiol 2010, 91(2): 243-247
process the zinc concentration increased a little, the
copper concentration was lower and the magnesium
concentration remained at the same level. The
detoxification process lasted from 3 to 20 days
(15,16). It was also shown that the maintenance of
the correct magnesium blood level in heroin-addicted
persons may be connected with the releasing of this
mineral from tissues [14].
The data concerning blood concentrations of the
above-mentioned elements during the methadone
treatment of 5 years and longer were not found in the
literature.
The changes of minerals eaten by addicted
persons during the methadone treatment do not have
to parallel with the changes of their concentration
in blood (abnormal expenditure/requirement
for nutrients and energy, malabsorption, limited
absorption surface) but clinical observations indicate
that it is necessary to deliver individual dietetic care to
addicted persons. It has been documented that use of
drugs (heroin, phensedyl, cannabis) induces multiple
nutrient deficiencies or malnutrition, which is the
most common cause of immunodeficiency. [17]. The
use of these drugs undermines appetite and affects
dietary habits [18] making those who are drugdependent crave empty-calorie nutrient-deficient
foods [20]. This may cause micronutrient deficiencies
(zinc, copper and magnesium), which may lead to
immunosuppressive complications and other problems
in general health status of addicted persons.
Zinc determines to some degree the mental
condition and is also very important for the immunity
level. Big shortages of this mineral worsen the
functions of basic cells of the immunological system.
The zinc shortage influences lymphopoesis – it lowers
the lymphocyte number [9]. Its metalloenzymes
are involved in cognitive functioning, reproductive
maturation and physiological growth [19].
Copper can impact the nervous system enzymes –
such as dopamine beta-hydroxylase, monoaminoxidase
or galactotransferase – as well as tyrosinase, the
enzyme taking part in the melatonin synthesis.
Similarly to zinc, copper has a key function in a free
radical inactivation [21].
Magnesium plays an important role not only in
metabolic changes of proteins and fatty acids but also
in the proper functioning of nervous, muscular and
circulatory systems [10].
Deficiency of any of the above-mentioned
elements badly affects normal functions of the human
body [22,23].
Kolarzyk E i wsp. Zinc, copper and magnesium intake in a daily diet in opiate-addicted persons before and after ...
Conclusions
1. The copper intake was much below the norm (safe
level – 10%) both in addicted men and addicted
women, though in the women after 5 years of
methadone treatment the increase of this element
intake was clearly seen.
2. The zinc consumption was lower than the norm
(safe level – 10%) before and after treatment,
whereas in women after 5 years of methadone
treatment the intake of this element was a little
higher than the safe level +10%.
247
3. In magnesium, the pattern of changes connected
with gender and methadone treatment was the
same as for zinc.
4. The examination results showed incorrect nutritional behaviors and were the reason to motivate
addicted patients to respect recommendations
concerning the microelements consumption. The
examinations were one of the elements of multidimensional care over addicted persons, aiming
to help addicted people in recovery.
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