British Journal of Nutrition

Full Papers

Indicators of zinc status at the population level: a review of the evidence

Rosalind S. Gibsona1 c1, Sonja Y. Hessa2, Christine Hotza3 and Kenneth H. Browna2a4

a1 Department of Hunan Nutrition, University of Otago, Union Street, PO Box 56, Dunedin 9015, New Zealand

a2 Department of Nutrition, University of California, Davis, CA, USA

a3 Harvest Plus, Washington, DC, USA

a4 Helen Keller International, Dakar, Senegal


The role of zinc deficiency as an important cause of morbidity and impaired linear growth has prompted the need to identify indicators of population zinc status. Three indicators have been recommended – prevalence of zinc intakes below the estimated average requirement (EAR), percentage with low serum zinc concentrations, and percentage of children aged < 5 years who are stunted. This review outlines steps to estimate the prevalence of inadequate intakes, and confirm their validity based on the EARs set by International Zinc Nutrition Collaborative Group. Next, the appropriateness of serum zinc as a biochemical marker for population zinc status is confirmed by a summary of: (a) the response of serum zinc concentrations to zinc intakes; (b) usefulness of serum zinc concentrations to predict functional responses to zinc interventions; (c) relationship between initial serum zinc and change in serum zinc in response to interventions. Height- or length-for-age was chosen as the best functional outcome after considering the responses of growth, infectious diseases (diarrhoea, pneumonia), and developmental outcomes in zinc supplementation trials and correlation studies. The potential of other zinc biomarkers such as zinc concentrations in hair, cells, zinc-metalloenzymes, and zinc-binding proteins, such as metallothionein, is also discussed. Molecular techniques employing reverse transcriptase (RT)-polymerase chain reaction to measure mRNA in metallothionein and ZIP1 transporter hold promise, as do kinetic markers such as exchangeable zinc pools (EZP) and plasma zinc turnover rates. More research is needed to establish the validity, specificity, sensitivity, and feasibility of these new biomarkers, especially in community-settings.


c1 Corresponding author: Rosalind S. Gibson, fax +64-3-479-7958 (Office), email Rosalind.Gibson@Stonebow.Otago.AC.NZ