The Relationship between Trace Elements and Depression among Older Patients with Chronic Liver Disease
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Geriatrics & Gerontology department, Faculty of Medicine, Ain Shams University, Cairo, EGYPT
Clinical Pathology department; Faculty of Medicine, Ain Shams University, Cairo, EGYPT
Online publication date: 2020-04-05
Publication date: 2020-04-05
Electron J Gen Med 2020;17(5):em224
The prevalence of Chronic Liver Disease (CLD) is rising in the older population, older patients with CLD had a Poor Quality of Life (QOL) as they may present with emotional reactions reaching to depression with a deleterious effect on their life. Trace Elements (TEs) and macro-minerals levels may be varied in CLD. They are linked with depression.

Our aim is to detect the association between TEs, macro-minerals, and depression among older patients with CLD.

Materials and Methods:
A cross-sectional study was conducted among 147 older patients with CLD. Depression was confirmed by the Patient Health Questionnaire (PHQ-9). Liver function tests, electrolytes and TEs (zinc (Zn) and copper (Cu)) were measured.

The prevalence of depression was 53.7%. Low serum sodium (Na) and calcium (Ca) levels were statistically significantly related to depression (P-value: 0.020 and 0.000 respectively) with lower serum Magnesium(Mg), serum Phosphorous(P) compared to higher serum Cu levels among depressed than non-depressed CLD, however no difference regarding serum Potassium (K) and Zn levels.By using univariate logistic regression, lower serum Na and Ca levels, malnutrition and diuretics were related to depression among CLD patients (P-value: 0.023, 0.001,0.000, 0.013 respectively ). While by using multivariate logistic regression, malnutrition and low serum Ca levels were significantly associated with depression among older CLD patients (P-value: 0.001 and 0.014 respectively)

Using diuretics and malnutrition are associated with depression through their effect on serum TEs and macro-minerals. Treating malnutrition and adjusting the dose of diuretics may decrease the risk of depression.

Marcellin P, Kutala, BK. Liver diseases: A major, neglected global public health problem requiring urgent actions and large-scale screening. Liver Int. 2018;38:2-6. https://doi.org/10.1111/liv.13... PMid:29427496.
Marcus E, Tur-Kaspa R. Viral Hepatitis in Older Adults. JAGS. 1997;45:755-63. https://doi.org/10.1111/j.1532... PMid:9180674.
Neff G, Duncan C, Schiff E. The current economic burden of cirrhosis. Gastroenterol Hepatol. 2011;7(10):661-71.
Frith J, Jones D, Newton JL. Chronic liver disease in an ageing population. Age Ageing. 2008;38:11-8. https://doi.org/10.1093/ageing... PMid:19029099.
Remick RA. Diagnosis and management of depression in primary care: a clinical update and review. CMAJ. 2002;167:1253-60.
Thomas AJ, O’Brien JT. Mood disorders in the elderly. Psychiatry. 2009;8:56-60. https://doi.org/10.1016/j.mpps....
Diez-Quevedo C, Lupón J, González B, et al. Depression, antidepressants, and long-term mortality in heart failure. Int J Cardiol. 2013;167:1217-25. https://doi.org/10.1016/j.ijca... PMid:22507552.
Gutteling JJ, De-Man RA, Busschbach JJ, Darlington AE. Health-related quality of life and psychological correlates in patients listed for liver transplantation. HEPATOL INT. 2007;1:437-43. https://doi.org/10.1007/s12072... PMid:19669339 PMCid:PMC2717547.
Weinstein AA, Kallman Price J, Stepanova M, et al. Depression in patients with nonalcoholic fatty liver disease and chronic viral hepatitis B and C. Psychosomatics 2011;52:127-32. https://doi.org/10.1016/j.psym... PMid:21397104.
Butterworth RF. Pathophysiology of hepatic encephalopathy: The concept of synergism. HEPATOL RES. 2008;38:S116-S121. https://doi.org/10.1111/j.1872... PMid:19125942.
Kolachi NF, Kazi TG, Afridi HI, et al. Investigation of essential trace and toxic elements in biological samples (blood, serum and scalp hair) of liver cirrhotic/cancer female patients before and after mineral supplementation. Clin Nutr. 2012;31:967-73. https://doi.org/10.1016/j.clnu... PMid:22607713.
Ko W, Guo C, Yeh M, et al. Blood micronutrient, oxidative stress, and viral load in patients with chronic hepatitis C. World J Gastroenterol. 2005;11:4697-702. https://doi.org/10.3748/wjg.11... PMid:16094713 PMCid:PMC4615414.
Hovatta I, Juhila J, Donner J. Oxidative stress in anxiety and comorbid disorders. J. Neurosci. Res. 2010;68:261-75. https://doi.org/10.1016/j.neur... PMid:20804792.
Moylan S, Berk M, Dean OM, et al. Oxidative & nitrosative stress in depression: Why so much stress? Neurosci Biobehav Rev 2014;45:46-62. https://doi.org/10.1016/j.neub... PMid:24858007.
Schaefer M, Capuron L, Friebe A, et al. Hepatitis C infection, antiviral treatment and mental health: A European expert consensus statement. J. Hepatol. 2012;57:1379-90. https://doi.org/10.1016/j.jhep... PMid:22878466.
Mansoor S, Haider A, Ramzan Z, Usman R. Frequency and Sociodemographic Determinants of Depression in Patients with Chronic Liver Disease. J Dow Univ Health Sci. 2018;12(1):17-20. https://doi.org/10.36570/jduhs....
Islam MR, Islam MR, Shalahuddin Qusar MM, et al. Alterations of serum macro-minerals and trace elements are associated with major depressive disorder: a case-control study. BMC Psychiatry. 2018;18:94. https://doi.org/10.1186/s12888... PMid:29631563 PMCid:PMC5891975.
Thi Thu Nguyen T, Miyagi S, Tsujiguchi H, et al. Association between Lower Intake of Minerals and Depressive Symptoms among Elderly Japanese Women but Not Men: Findings from Shika Study. Nutrients. 2019;11:389 pii: E389. https://doi.org/10.3390/nu1102... PMid:30781841 PMCid:PMC6412241.
Pugh RN, Murray-Lyon IM, L Dawson J, Pietroni MC, Williams J. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646-9. https://doi.org/10.1002/bjs.18... PMid:4541913.
Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41:1284-92. https://doi.org/10.1097/01.MLR... PMid:14583691.
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA.1999;282:1737-1744. https://doi.org/10.1001/jama.2... PMid:10568646.
Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging.2006;10:456-465. https://doi.org/N6720012/9910M.
Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront. 2001;56:M3366-3773. https://doi.org/10.1093/gerona... PMid:11382797.
Guigoz Y. The Mini-Nutritional Assessment (MNA® ) Review of the Literature - What does it tell us?. J Nutr Health Aging.2006;10:466-487.
Charlton MR, Burns JM, Pedersen RA, Watt KD, Heimbach JK, Dierkhising RA. Frequency and Outcomes of Liver Transplantation for Nonalcoholic Steatohepatitis in the United States, Gastroenterology.2011;141:1249-1253. https://doi.org/10.1053/j.gast... PMid:21726509.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62. https://doi.org/10.1136/jnnp.2... PMid:14399272 PMCid:PMC495331.
Le Strat Y, Le Foll, B, Dubertret C. Major depression and suicide attempts in patients with liver disease in the United States. LIVER INT. 2014; 35 (7), 1910-1916. https://doi.org/10.1111/liv.12... PMid:24905236.
Vikas S, Ramesh M, Rani VN, Thennarasu P, Kannan G. Incidence of diuretics induced adverse drug reactions in an intensive cardiac care unit of a tertiary care teaching hospital. Int. J. Pharm. Sci.2017;8: 3557-3562. https://doi.org/10.13040/IJPSR....
Vafaei Z, Mokhtari H, Sadooghi Z, Meamar R, Chitsaz A, Moeini M. Malnutrition is associated with depression in rural elderly population. Int J Res Med Sci.2013;18: S15-S9.
Cabrera MA, Mesas AE, Garcia AR, DeAndrade SM. Malnutrition and Depression among Community-dwelling Elderly Peopl. JAMDA. 2007;8:582-4. https://doi.org/10.1016/j.jamd... PMid:17998114.
Saunders J, Brian A, Wright M, Stroud M. Malnutrition and nutrition support in patients with liver disease. Frontline Gastroenterol. 2010;1(2):105-11. https://doi.org/10.1136/fg.200... PMid:28839557 PMCid:PMC5536776.
Sathyanarayana Rao T, Asha M, Ramesh B, Jagannatha Rao K. Understanding nutrition, depression and mental illnesses. Indian J. Psychiatry. 2008;50:77-82. https://doi.org/10.4103/0019-5... PMid:19742217 PMCid:PMC2738337.
Ozdemir O, Soyoral Y, Isi M, Ozdemir P, Balahoroglu R. Is there any relationship between sodium and depression? J. Mood Disord. 2014;4:163-6. https://doi.org/10.5455/jmood.....
Sivaraman S, Rajajeyakumar M. Psychiatric Aspects of Hyponatremia - A Clinical Approach. J Psychol Psychother. 2016;6:1-2. https://doi.org/10.4172/2161-0....
Miki T, Kochi T, Eguchi M, Kuwahara K. Dietary intake of minerals in relation to depressive symptoms in Japanese employees: The Furukawa Nutrition and Health Study. Nutrition. 2015;31:686-90. https://doi.org/10.1016/j.nut.... PMid:25837213.
Bae Y, Kim S. Low dietary calcium is associated with self-rated depression in middle-aged Korean women. Nutr Res Pract. 2012;6:527-33. https://doi.org/10.4162/nrp.20... PMid:23346303 PMCid:PMC3542443.
Zieba A, Kata R, Dudek D, Schlegel-zawadzka M, Nowak G. Serum trace elements in animal models and human depression: Part III. Magnesium. Relationship with copper, Human Psychopharmacology. Clinical and Experimental. 2000;15:631-5. https://doi.org/10.1002/hup.23... PMid:12404616.
Derom M, Sayón-Orea C, Martínez-Ortega JM, Martínez-González MA. Magnesium and depression: a systematic review. Nutr. Neurosci. 2013;16:191-206. https://doi.org/10.1179/147683... PMid:23321048.
Cubała WJ, Landowski J, Dziadziuszko M, Chrzanowska, A, Wielgomas B. Magnesium, C-reactive protein, and cortisol in drug-naïve patients with short illness-duration, first episode major depressive disorder: possible immunomodulatory role for magnesium.Magnesium RES. 2016;29:169-74. https://doi.org/10.1684/mrh.20... PMid:27965189.
Yüksel C, Öngür D, Magnetic Resonance Spectroscopy Studies of Glutamate-Related Abnormalities in Mood Disorders. Biol Psychiatry. 2010;68:785-94. https://doi.org/10.1016/j.biop... PMid:20728076 PMCid:PMC2955841.
Grønli O, Kvamme JM, Friborg O, Wynn RR. Zinc Deficiency Is Common in Several Psychiatric Disorders. PLoS ONE. 2013;8:e82793. https://doi.org/10.1371/journa... PMid:24367556 PMCid:PMC3868572.
Siwek M, Szewczyk B, Dudek D, et al. Zinc as a marker of affective disorders. Pharmacol Rep. 2013;65:1512-8. https://doi.org/10.1016/s1734-....
Pramoolsinsap C, Promvanit N, Komindr S, Lerdverasirikul P. Serum trace metals in chronic viral hepatitis and hepatocellular carcinoma in Thailand. J Gastroenterol. 1994;29:610-615. https://doi.org/10.1007/bf0236... PMid:8000510.
Yoshida Y, Higashi T, Nouso K, et al. Effects of zinc deficiency/zinc supplementation on ammonia metabolism in patients with decompensated liver cirrhosis. Acta Medica Okayama. 2001;55:349-55. https://doi.org/10.18926/AMO/3....
Schlegel-Zawadzka M, Zięba A, Dudek D, et al. Serum trace elements in animal models and human depression. Part II. Copper. Hum Psychopharm Clin. 1999;14:447-51. https://doi.org/10.1002/(sici)...<447:aid-hup106>3.0.co;2-f.
Młyniec K, Gaweł MU, Doboszewska U, et al. Essential elements in depression and anxiety. Part II. Pharmacol Rep. 2015;67:187-94. https://doi.org/10.1016/j.phar... PMid:25712638.
Kaner M, Soylu G, Yüksel N, Inanç N, Ongan D, Başmısırlı E. Evaluation of Nutritional Status of Patients with Depression. Biomed Res. Int. 2015:1-9. https://doi.org/10.1155/2015/5... PMid:26413529 PMCid:PMC4564617.