British Journal of Nutrition

Systematic Review with Meta-analysis

The relationship between zinc intake and serum/plasma zinc concentration in adults: a systematic review and dose–response meta-analysis by the EURRECA Network

Nicola M. Lowea1 c1, Marisol Warthon Medinaa1, Anna-Louise Stammersa1, Sujata Patela1, Olga W. Souvereina2, Carla Dullemeijera2, Lluis Serra-Majema3, Mariela Nissensohna3 and Victoria Hall Morana4

a1 International Institute of Nutritional Sciences and Food Safety Studies, University of Central Lancashire, Preston PR1 2HE, UK

a2 Division of Human Nutrition, Wageningen University, PO Box 8129, 6700 EV, Wageningen, The Netherlands

a3 Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Spain

a4 Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston PR1 2HE, UK


Dietary Zn recommendations vary widely across Europe due to the heterogeneity of approaches used by expert panels. Under the EURopean micronutrient RECommendations Aligned (EURRECA) consortium a protocol was designed to systematically review and undertake meta-analyses of research data to create a database that includes ‘best practice’ guidelines which can be used as a resource by future panels when setting micronutrient recommendations. As part of this process, the objective of the present study was to undertake a systematic review and meta-analysis of previously published data describing the relationship between Zn intake and status in adults. Searches were performed of literature published up to February 2010 using MEDLINE, Embase and the Cochrane Library. Data extracted included population characteristics, dose of Zn, duration of study, dietary intake of Zn, and mean concentration of Zn in plasma or serum at the end of the intervention period. An intake–status regression coefficient () was estimated for each individual study, and pooled meta-analysis undertaken. The overall pooled for Zn supplementation on serum/plasma Zn concentrations from randomised controlled trials and observational studies was 0·08 (95 % CI 0·05, 0·11; P < 0·0001; I 2 84·5 %). An overall of 0·08 means that for every doubling in Zn intake, the difference in Zn serum or plasma concentration is (20·08 = 1·06), which is 6 %. Whether the dose–response relationship, as provided in the present paper, could be used as either qualitative or quantitative evidence to substantiate the daily Zn intake dose necessary to achieve normal or optimal levels of biomarkers for Zn status remains a matter of discussion.

(Received May 10 2012)

(Revised July 06 2012)

(Accepted July 06 2012)

(Online publication November 13 2012)

Key Words:

  • Zinc;
  • Dose–response relationships;
  • Systematic reviews;
  • Meta-analyses


c1 Corresponding author: Nicola Lowe, fax +44 1772 892925, email


  Abbreviations: EURRECA, EURopean micronutrient RECommendations Aligned; RCT, randomised controlled trial; UEA, University of East Anglia; WU, Wageningen University