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Efficacy of Zinc Supplement in Minimal hepatic Encephalopathy: A prospective, Randomized Controlled Study (Zinc-MHE
Rattaya Janyajirawong1, Ratha-Korn Vilaichone2,3, Supatsri Sethasine1
1Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Background:
Minimal hepatic encephalopathy (MHE) in patients with cirrhosis of the liver has a negative impact on the quality of daily life by impairing attention, memory and visuomotor coordination, and resulting in cognitive decline. Ammonia is thought to be part of the pathogenesis of hepatic encephalopathy. Zinc is an essential trace element, one of the cofactor enzymes that is essential for the conversion of ammonia to urea.
Aim:
To assess the effect of zinc supplementation on psychomotor performance in cirrhotic patients with MHE.
Methods:
This prospective, randomized, controlled trial recruited 69 cirrhotic patients (age 18-75 years) diagnosed with MHE by neuropsychometric (NP) tests comprised of the number connection test part A (NCT-A), number connection test part B (NCT-B), serial dot test (SDT), line tracing test (LTT) and digit symbol test (DST). Eligible patients were randomly assigned (1:1) by a computer-based system block of four randomizations to receive 45 mg of elemental zinc or placebo for 12 weeks. The primary endpoint was the absolute change in NP tests from baseline to 12-weeks of zinc supplement compared with placebo. The assessment of changes of the health-related quality of life (HRQOL) using the Short Form survey-36 (SF-36) questionnaire, as well as biochemical parameters including serum ammonia, was also conducted in both groups.
Results:
From January to December 2020, 125 eligible cirrhotic patients were diagnosed with liver cirrhosis, of whom 69 (55%) had MHE and were randomly assigned to treatment: 35 patients were assigned to receive 45 mg of elemental zinc and the others 34 patients to receive placebo. Significant improvements in NP tests were established in the zinc supplement group when compared with the placebo group (NCT-A, p = 0.029; NCT-B, p = 0.008; SDT, p = 0.002; DST, p = <0.001). A significant improvement of HRQOL assessed by the SF-36 score was only seen in the zinc group (p<0.001). In the zinc supplement group, not only was an improvement in psychomotor performance reported, but quality of life was also improved, irrespective of baseline zinc level.
Conclusion:
Twelve weeks of zinc supplement in cirrhotic patients with MHE not only had a positive effect on psychomotor performance but also improved HRQOL irrespective to baseline zinc level.
Insights
Zinc supplementation significantly improved psychomotor performance and quality of life in cirrhotic patients with minimal hepatic encephalopathy (MHE). This 12-week intervention showed benefits regardless of baseline zinc levels, offering a potential therapeutic strategy.
Area of Science:
- Hepatology
- Neuroscience
- Nutritional Science
Background:
- Minimal hepatic encephalopathy (MHE) in cirrhosis patients impairs cognitive functions like attention and memory, negatively impacting daily life.
- Elevated ammonia levels are implicated in MHE pathogenesis.
- Zinc, an essential trace element, acts as a cofactor in ammonia-to-urea conversion.
Purpose of the Study:
- To evaluate the efficacy of zinc supplementation in enhancing psychomotor performance in cirrhotic patients diagnosed with MHE.
- To assess the impact of zinc on health-related quality of life (HRQOL) and biochemical parameters.
Main Methods:
- A prospective, randomized, controlled trial involving 69 cirrhotic patients with MHE.
- Participants received either 45 mg of elemental zinc or a placebo daily for 12 weeks.
- Psychomotor performance was assessed using standardized neuropsychometric (NP) tests; HRQOL was measured with the SF-36 questionnaire.
Main Results:
- Zinc supplementation led to significant improvements in multiple NP tests compared to placebo (p < 0.05 for NCT-A, NCT-B, SDT, DST).
- Patients receiving zinc showed a significant improvement in HRQOL scores (SF-36, p < 0.001).
- Benefits in psychomotor performance and HRQOL were observed irrespective of baseline zinc levels.
Conclusions:
- Twelve weeks of zinc supplementation positively impacts psychomotor performance in cirrhotic patients with MHE.
- Zinc supplementation also enhances health-related quality of life in this patient population.
- The therapeutic benefits of zinc are evident regardless of the patient's baseline zinc status.
