A CAJM article on IBD.Inflammatory bowel diseases (IBD) are a group of chronic inflammatory process of the bowel whose aetiology is unknown and are seen commonly in Caucasians and Jews, but rarely in blacks.1,2 These conditions are characterised by recurrent bloody diarrhoea, abdominal pain, tenesmus, malaise, perianal abscess and anaemia resulting in malabsorption and increased loss of nutrients.3
Zinc and selenium have been reported to be low in adults with IBD4,S and children with allergic colitis.6 Zinc deficiency leads to a decreased natural killer cell activity.7,8 There are conflicting reports of the copper status of adults with IBD.9,10 Oxygen free radicals mediate tissue injuries and a high level of free radicals has been observed in IBD.9 Antioxidant agents of which selenium and zinc are important mop up these free radicals.
The available literature on the trace element status of children with inflammatory bowel disease is limited. Since trace elements are scavengers of free radicals, and since free radicals are high in IBD, this study aims at estimating the levels of the trace elements in children with IBD

Keith, L.

Ojuawo, A.

Central African Journal of Medicine

English

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The serum concentrations of zinc, copper and selenium in 
children with inflammatory bowel disease
*A OJUAWO, * *L KEITH
Abstract
Objective: To estimate the levels of trace elements in children with inflammatory bowel disease (IBD). 
Design: Prospective cross sectional study
Setting: Gastroentrology Unit, Great Ormond Street Children’s Hospital, London, UK.
Subjects: Seventy four children with inflammatory bowel disease confirmed endoscopically and histologically 
(38 ulcerative colitis and 36 Crohn’s disease) and 40 age matched controls had their serum zinc, copper and 
selenium assayed at presentation.
Main outcome measure: Serum levels of zinc, copper and selenium in children with inflammatory bowel 
disease and age matched controls.
Results: Seventy four children with inflammatory bowel disease confirmed endoscopically and histologically 
(38 ulcerative colitis and 36 Crohn’s disease) and 40 age matched controls had their serum zinc, copper and 
selenium assayed at presentation. The serum levels of selenium were significantly lower in cases of ulcerative 
colitis 0.63 ± 0.25 mmol/L and Crohn’s disease 0.69 ± 0.25 mmol/L than in the controls 0.84 ± 0.13 mmol/ 
L (p<0.01). The serum copper concentration was significantly higher in those with Crohn’s disease 22.7 ± 5.49 
mmol/L than in those with ulcerative colitis 17.6 ±5.15 mmol/L and the controls 20.76 ± 4.06 mmol/L 
(p<0.01). Children with Crohn’s disease had a lower serum zinc level 11.01 ± 2.49 mmol/L compared to the 
control level of 13.6 ± 1.63 mmol/L (p<0.05), but the levels were not significantly different in the controls 
and ulcerative colitis (p>0.10). Children with inflammatory bowel disease have abnormal levels of the trace 
elements which is more marked in those with Crohn’s disease.
Conclusion: Children with IBD in this study show abnormalities of the trace elements which is probably a 
result of inadequate intake, reduced absorption, increased intestinal loss due to impairment of the absorption 
as a result of the inflammatory process. The reduced free radical scavenging action of zinc and selenium as 
a result of their deficiency may contribute to the continued inflammatory process of IBD. The recommendation 
of the supplementation of these trace elements in IBD is further supported by the findings of this study in 
children.
Cent AfrJ Med 2002;48(9/l): 116-9
*Department of Paediatrics
**Gastroenterology Unit
Great Ormond Street Children’s Hospital
London
WC INI EH
Correspondence to:
Dr Ayodele Ojuawo 
Department o f Paediatrics 
University of llorin Teaching Hospital 
PM B1459 
llorin, Nigeria
E mail: ojuawo@ilorin.skannet.com
Cent Afr J  Med 2002;48(9/10) 116
Introduction
Inflammatoryabowel diseases (IBD) are a group of chronic 
inflammatory process of the bowel whose aetiology is 
unknown and are seen commonly in Caucasians and Jews, 
but rarely in blacks.1,2 These conditions are characterised 
by recurrent bloody diarrhoea, abdominal pain, tenesmus, 
malaise, perianal abscess and anaemia resulting in 
malabsorption and increased loss of nutrients.3
Zinc and selenium have been reported to be low in adults 
with IBD4,S and children with allergic colitis.6 Zinc 
deficiency leads to a decreased natural killer cell activity.7,8 
There are conflicting reports of the copper status of adults 
with IBD.9,10 Oxygen free radicals mediate tissue injuries 
and a high level of free radicals has been observed in IBD.9 
Antioxidant agents of which selenium and zinc are important 
mop up these free radicals.
The available literature on the trace element status of 
children with inflammatory bowel disease is limited. Since 
trace elements are scavengers of free radicals, and since 
free radicals are high in IBD, this study aims at estimating 
the levels of the trace elements in children with IBD.
Materials and Methods
Seventy four children with histologically confirmed IBD 
and 40 healthy controls had their serum zinc, cooper and 
selenium levels assayed before the commencement of 
therapy at the Great Ormond Street Children’s Hospital, 
London over a nine months period. All the patients had 
endoscopies with biopsies done and were grouped based 
on endoscopic and histological findings.
Anti-endomysial, antireticulin and antigliadin antibodies 
were negative in all the patients studied, including the 
controls, to exclude those with Gluten Induced Enterpathy. 
Histological Diagnostic Criteria.
Crohn’s disease — transmural inflammatory; focal 
inflammatory cell aggregation with non caseating epitheloid 
granuloma formation.
Ulcerative colitis — diffuse mucosal inflammatory cell 
infiltration, with crypt architectural distortion, loss of 
goblet cells and paneth cell metaplasia.
Blood samples were obtained at presentation before the 
commencement of therapy.
Zinc was analysed by flame atomic absorption 
photometry, selenium by hydride atomic absorption 
spectrometry and copper by furnace eletrothermal 
atomization absorption spectrometry. Quality assurance 
was ascertained using a commercially prepared reference.
The values were expressed as the mean and standard 
deviation and the values in the three groups were compared 
using the two-tailed Student’s t-test, Pearson correlation 
coefficient to test correlation where applicable.
Results
Seventy four children with IBD (36 with Crohn’s disease 
and 38 with ulcerative colitis) had endoscopic and 
histological assessment of the gastro-intestinal tract done
in this study. The pathological findings were more marked 
in the terminal ileum and proximal large bowel in Crohn’s 
disease, (63.9%) and the distal large bowel and rectosigmoid 
colon in ulcerative colitis (60.5%), (Table I).
Table I: The part of the gastro-intestinal tract involved in 
the disease process during endoscopic examination in 
Crohn’s disease and ulcerative colitis.
Crohn’s disease 
n = 36
Ulcerative colitis 
n = 38
Terminal Ileum 15(41.7%) 2 (5.3%)
Proximal large bowel 8 (22.2%) 5(13.2%)
Descending colon 3 (8.3%) 8(21.1%)
Recto sigmoid colon 2 (5.6%) 17(44.7%)
Combined 8 (22.2%) 6(15.8%)
Table II shows that the mean age of the controls and the 
children with IBD were comparable in this study (p>0.10). 
The mean serum level of copper 22-7 ± 5.49 mmol/L was 
significantly higher in Crohn’s disease than in ulcerative 
colitis 17.59 ± 5.17 mmol/L, and controls (p<0,01). Both 
ulcerative colitis (0.63 ± 0.1 mmol/L) and Crohn’s disease 
(0.69 ± 0.25 mmol/L) patients had significantly lower 
levels of selenium than the controls (0.84 ± 0.13 mmol/L), 
p<0.001. There is a significantly lower zinc level in Crohn’s 
disease than in the controls (p<0.05), but the levels were 
comparable in ulcerative colitis and the controls (p<0.05).
Table II: The serum concentration of zinc, copper, 
selenium and albumin in Crohn’s disease, ulcerative colitis 
and the controls.
Crohn’s disease Controls Ulcerative colitis
n = 36 n = 40 n = 38 _
Age (months)
Zinc (mmol/L) 
Copper (mmol/L) 
Selenium (mmol/L) 
Albumin (Gm/L)
94.18 ±42.56 
11.01 ±2.49** 
22.7 ± 5.49**
85.38 ±47.56 
13.6 ±1.63 
20.76 ± 4.01 
0.84 ±0.13 
42.2 ± 4.06
Selenium
81.38 ±22.04
12.39 ±3.0** 
17.59 ±5.17**
0.63 ±0.1** 
38.0 ±6.14**
Albumin Age
0.69 ± 0.25**
36.95 ±6.15** 
p value for above table.
Zinc Copper
Crohn's disease vs
Control
Ulcerative colitis vs
<0.005 <0.025 <0.005 <0.001 >0.25
Control <0.05 <0.001 <0.001 <0.005 >0.10
* *  Indicates that statistical comparison is significant.
Table III: The correlation between the age and the serum 
concentrations of zinc, copper and selenium in children 
with Crohn’s disease and ulcerative colitis.
Crohn's disease (n = 36) Ulcerative colitis (n = 38) 
Copper Zinc Selenium Copper Zinc Selenium
mmol/L mmol/L mmol/L mmol/L mmol/L mmol/L
0-5 yrsn=7 24.8 11.3 0.63 n=8 18.2 12.1 0.59
5-1°yrs„=t, 22.9 10.9 0.72 n=8 17.5 12.5 0.63
>1°yrsn=ie 21.3 11.3 0.69 n=22 17.3 12.3 0.63
Y -0.29 0.05 0.23 -0.15 0.02 0.28
P <0.001 *NS <0.001 <0.05 *NS <0.001
*NS is not significant.
Cent Afr J Med 2002;48(9/10) 117
The albumin levels were significantly lower in ulcerative 
colitis and Crohn’s disease compared to the controls 
(p<0.005).
There is a low positive correlation between the age and 
selenium levels in both Crohn’s disease and ulcertive 
colitis (r=0.22 and 0.28, p<0.005 respectively), but there is 
a negative correlation between the age and copper in 
Crohn’s disease (r= -0.28, p<0.001) which is more marked 
than in ulcerative colitis (r= -0.15, p<0.05).
Children below the age of five years tend to have a more 
marked derangement of the trace elements compared to the 
older children. Children with an extensive involvement of 
the bowel had significantly higher copper and lower 
selenium and albumin levels than those with distal large 
bowel involvement only (p<0.025).
Discussion
Children with ulcerative colitis and Crohn’s disease in this 
study have low serum concentrations of selenium, which is 
similar to the findings in the adults with early stage 
Crohn’s disease and ulcerative colitis.10'11 Those children 
with Crohn’s disease had very significantly lower levels of 
zinc when compared to the controls, a finding that is in 
consonance with previous reports in adults11 but in contrast 
with that of some other workers.10
Increased natural killer cell activity has been linked to 
zinc deficiency.13'14 The low zinc and selenium levels in 
IBD in children could be as a result of reduced intake, 
reduced absorption or increased mobilisation for mopping 
up free radicals which contribute to tissue injury in these 
conditions.414 The positive correlation between zinc and 
albumin is well recognised,14 and patients with IBD have 
low albumin levels probably due to malabsorption or 
reduced intake. Whether the low zinc level is as a result of 
- hypoalbuminaemia or increased utilisation for free radical 
mop up is not clear.
In this study, there was a significantly increased copper 
level in children with Crohn’s disease but not in those with 
ulcerative colitis, a finding that is similar to that seen in the 
adults.10,11 Copper level is known to be elevated under 
inflammatory conditions and this has been attributed to 
increased ceruloplasmin.11
The possible role of excess copper catalysing free radical 
formation and increased mucosal oxidative stress in IBD is 
plausible.
The trace elements are more deranged in children with 
Crohn’s disease than in ulcerative colitis in this study. 
Previous workers have shown that there is no correlation 
between the part of the intestine involved and the disease 
process.10 We did not observe any correlation between the 
sex and the trace element levels in children with IBD, 
which is contrary to the observation in adult Crohn’s 
disease and ulcerative colitis.10 There is a positive correlation 
between selenium levels and age, but a negative correlation 
between copper levels and age in both Crohn’s disease and 
ulcerative colitis in this study. This will tend to suggest a 
cumulative effect of increased copper and decreased
selenium levels, which will favour further tissue injury and 
inflammation.
The linkage between zinc and natural killer cell activity 
has prompted a recommendation of zinc supplementation 
in patients with mild to moderately active IBD3’15 and 
allergic colitis.6
Children with IBD in this study show abnormalities of 
the trace elements which is probably a result of inadequate 
intake, reduced absorption, increased intestinal loss due to 
impairment of the absorption as a result of the inflammatory 
process. The reduced free radical scavenging action of zinc 
and selenium as a result of their deficiency may contribute 
to the continued inflammatory process of IBD. The 
recommendation of the supplementation of these trace 
elements in IBD is further supported by the findings of this 
study in children.
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14. Egawa S, Hiwatachi N. Natural killer cell activity in 
patients with inflammatory bowl disease. /  Clin Lab 
Immunol 1986;20:187-92.
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The serum concentrations of zinc, copper and selenium in children with inflammatory bowel disease

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The serum concentrations of zinc, copper and selenium in children with inflammatory bowel disease

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