What is the role of trace elements like iron, copper or zinc?

With the help of a correlation analysis (in our case the Spearman Rank correlation analysis; a statistical measurement of the connection between different factors) we discovered that our data showed a noticeable link between metabolic factors (triglycerides, low HDL cholesterol, insulin, BMI, blood pressure) and the levels of iron and copper. While all of the students' test results showed normal levels of iron (ferritin: 15-300ng/ml), we could see that higher values always coincided with all of the risk factors pointed out earlier in this report. This kind of connection between elevated ferritin levels and an increased risk of diabetes and cardiovascular disease has already been established with adults. (7) Blood-letting (removal of iron from the body) has proved to be an effective treatment for this condition. However, so far no one has shown that this correlation between elevated ferritin levels and the aforementioned risks already exists in adolescents with ferritin levels that still fall within the normal range. This indicates an early involvement of slightly elevated ferritin levels in the emergence of fatty livers, high blood pressure and fat-metabolism disorder.

We also found a similar correlation between elevated levels of copper and the risk factors of metabolic syndrome. This is remarkable because it means copper may play a significant role in various aspects of the pathogenesis of lifestyle diseases. In adults, lower levels of copper tends to be particularly important. (8) However, a study from some years ago found that the exact opposite is possible: here, low copper coincided with low blood pressure and well-functioning arteries and veins in adolescents. Our results show a close correlation between elevated levels of copper, blood lipids, higher blood pressure and liver values. Thus a higher level of copper seems to be problematic in adolescents, even though other studies show that the opposite is the case for adults.

All blood samples were tested for their levels of zinc. However, our data analysis could not show a correlation between zinc and any of the symptoms described earlier in the report. It seems as if zinc can be ruled out as a contributing factor in the emergence of metabolic syndrome.

In order to illustrate the connections between the trace elements iron, copper and the

All in all we can tell from our results that the metabolism of copper and iron is related to Metabolic Syndrome. We think that an approach focusing on this interdependency could be used effectively as a preventive measure against Metabolic Syndrome in adolescents.

What is the role of nutrition and lifestyle?

Another important part of our project was to conduct a thorough survey on the students' eating habits. After we had analyzed the results from the blood tests and the physical examinations, we tried to relate these first results with the students' eating habits. We wanted to find out indicators for healthy and unhealthy lifestyles.

Eventually we also wanted to provide useful advice to those students' whose results were cause for concern. The data from the survey was digitalized and related to the test results via the Spearman rank correlation analysis. The most obvious - and to some of us surprising - connection to the various risk factors was to the regular consumption of alcohol, beer and spirits in particular. We found out that students who drank more than 4 beers per week already had bigger bellies and hips, and higher values for blood pressure and blood lipids. The topic of unhealthy alcohol consumption among adolescents, especially binge drinking, has recently been the focus of much attention in the Austrian media.

Our results point out another aspect to this problem, which will be of interest in a few decades, when the risks for heart attacks or strokes will rise. However, a regular and moderate consumption of wine, of red wine in particular, is regarded as prophylactic against those diseases.

Since our research only covered the students from our school, we cannot make any statements on whether alcohol as such is damaging to health or if the consumption of alcohol is just an indicator for a generally unhealthy lifestyle. The fact that alcohol contains many calories (7,1kCal/g alcohol) is indisputed. Excessive consumption might therefore lay the foundation for later overweight, obesity and related diseases. On top of this the amount of alcohol the students consumed was also closely related to the levels of ferritin, i.e. the higher the alcohol consumption, the higher the levels of iron.

The connection between alcohol and iron levels has already been established.(9) Furthermore, the connection between iron and the Metabolic Syndrome is also known.(7) So far, however, it has not been shown that those three might be related in adolescence as well, or that the consumption of alcohol during adolescence might contribute to the emergence of cardiovascular diseases.

The same connection was again established for students who claimed to have decreased their intake of fat over the course of the last year.

Concerning copper values we did not observe the connection between low copper and elevated risk factors of Metabolic Syndrome which can be found in adults. On the contrary, it became clear that higher levels of copper coincided with a stronger risk profile. Eating habits, fast food and alcohol consumption in particular, were related to a high level of copper in the blood count.

Summary:

From our research we could see that a significant trend toward lifestyle (”prosperity“) diseases like diabetes and high blood pressure should already be taken serious at an early, usually undetected, stage. High levels of copper and iron seem to be directly related to a pronounced risk profile for a later emergence of cardiovascular conditions and insulin resistance, even at a point where levels are medically still considered normal. Adults are often treated with blood-letting to remove the surplus of iron. Our results show that when treating adolescents, particular attention should be paid to elevated levels even if they are still within with the norm. We suggest that the role of copper needs to be investigated medically and physiologically, in order to establish whether it is only an accessory symptom or a factor itself. This approach might yield a further therapeutic starting point.

Finally, we were able to prove that both the consumption of alcohol and the number of meals per day were closely connected with the emerging risk factors.

In view of our results we think that students need to be offered more health education concerning the risks of eating habits, alcohol consumption and the risks of cardiovascular diseases and diabetes. As one part of our health care policy, such educational programmes need to be given more attention as potential preventative measures.

We are proud that as a result of our research a medical student will take up the topic for her thesis work. Other research papers on this subject are already being planned. Dr. Elmar Aigner and Univ. Professor Dr.

other risk factors examined, we plotted all data out in tables. We separated the results according to gender. We divided the results for copper and ferritin into four equal parts, i.e. the upper quartile, two middle quartiles and a lower quartile. Then we calculated the difference between the upper and the lower quartile. In table 3, higher levels in ferritin and copper always coincide with higher risk factors. For example, the upper quartile of the boys' ferritin level is between 243,5 and 100,8ng/ml, while the values in the lower quartile range from 43,9 to 12,5ng/ml. The first group - a quarter of all the students - also clearly had a higher BMI of 23,9 ±3,5 than the fourth group with the lowest ferritin level with a BMI of 20,4 ±2,4. Similarly, one can observe that those girls with the highest levels of copper (193-109μg/dl) also show significantly higher levels of triglycerides (105,8 ±39,6) than those girls with lower copper (cp. last line of fourth quartile, 80-64μg/dl). The level of triglycerides for this fourth group is at 68,1 ±23,0.

The bottom line of the table indicates the statistical significance of the differences between the quartile values. If this value drops below 0,001, then the probability for the results to be incidental falls below 0,1% as well. In other words, the probability that the compared results are directly related is at 99,9%. We also used the Mann-Whitney-U test and the t-test to compare the groups.

Another irregularity, which shed a new and interesting light on our habits, was the reciprocal connection between the number of meals students eat during the day and the physiological data we gathered.

Those who ate fewer meals a day also showed lower values for belly and hip girth, BMI and insulin (HOMA-IR). On the other hand we saw that students who regularly skipped meals (e.g. breakfast or dinner) compensated by eating more than necessary. Such a habit leads to more energy intake and overweight.

From these results we suggest that adolescents should be motivated to eat regularly, since this habit reduces calorie intake and, thus, reduces later cardiovascular risks. A similar connection exists between the number of diets, the BMI and the hip/belly girth. This merely reflects that students suffering from overweight are more likely to try out diets. However, these diets do not seem to be successful, as the measured values of those students are still above the values of the other students.

Christian Datz aim to continue scientific investigations in order to support our evaluations. For the first time ever, students of HLFS Ursprung will now have the chance to be co-authors on a paper published in a scientific journal.

bibliography

1. Moreno LA, Gonzalez-Gross M, Kersting M, Molnar D, de Henauw S, Beghin L, Sjostrom M, et al. Assessing, understanding and modifying nutritional status, eating habits and physical activity in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr 2008;11:288-299.
2. Olufadi R, Byrne CD. Clinical and laboratory diagnosis of the metabolic syndrome. J Clin Pathol 2008;61:697-706.
3. Bays HE. „Sick fat,“ metabolic disease, and atherosclerosis. Am J Med 2009;122:S26-37.
4. Morrison JA, Ford ES, Steinberger J. The pediatric metabolic syndrome. Minerva Med 2008;99:269-287.
5. Gardner M, Gardner DW, Sowers JR. The cardiometabolic syndrome in the adolescent. Pediatr Endocrinol Rev 2008;5 Suppl 4:964-968.
6. Watanabe S, Yaginuma R, Ikejima K, Miyazaki A. Liver diseases and metabolic syndrome. J Gastroenterol 2008;43:509-518.
7. Fernandez-Real JM, Lopez-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes 2002;51:2348-2354.
8. Aigner E, Theurl I, Haufe H, Seifert M, Hohla F, Scharinger L, Stickel F, et al. Copper availability contributes to iron perturbations in human nonalcoholic fatty liver disease. Gastroenterology 2008;135:680-688.
9. Harrison-Findik DD. Role of alcohol in the regulation of iron metabolism. World J Gastroenterol 2007;13:4925-4930.