{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T10:50:04Z","timestamp":1768387804696,"version":"3.49.0"},"reference-count":78,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Recessive dystrophic epidermolysis bullosa (RDEB) is a severe congenital genodermatosis characterized by skin and mucosa fragility, chronic inflammation, recurrent infections and high nutritional demands due to increased metabolism and epithelial barrier-related losses, placing patients at risk of zinc deficiency. We aimed to investigate the clinical relevance and biochemical determinants of zinc deficiency as a potentially modifiable contributor to disease burden in RDEB. Methods: In this cross-sectional study (n = 84), serum zinc levels were analyzed in association with sex, age, disease severity, percentage of body surface area (BSA) affected, inflammatory markers, infection burden, and common clinical complications including anemia and growth impairment. Results: Zinc deficiency, defined as levels below 670 \u00b5g\/L, was identified in 35% of patients and became more frequent after age 5 and during adulthood, particularly among those with more severe disease. Deficiency was strongly associated with anemia, inflammation, infection burden, growth impairment, and extensive skin involvement. A revised cutoff of 780 \u00b5g\/L is proposed, showing improved diagnostic performance for identifying patients at risk of systemic complications, and offering a more suitable threshold for starting preventive supplementation. Multivariate logistic modeling confirmed that low serum zinc independently predicted anemia risk, alongside transferrin saturation and C- reactive protein levels. Serum albumin was identified as the strongest determinant of zinc levels, partially mediating the effects of inflammation and skin involvement. Conclusions: These findings identify serum zinc as a clinically relevant marker of nutritional status and complication burden in RDEB. While no causal or therapeutic effects can be inferred from this cross-sectional study, the strong and biologically plausible associations observed suggest a rationale for systematic monitoring and correction of zinc deficiency as part of comprehensive supportive care, and warrant prospective studies to assess clinical benefit.<\/jats:p>","DOI":"10.3390\/nu18020232","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:25:23Z","timestamp":1768213523000},"page":"232","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Zinc as a Biomarker of Nutritional Status and Clinical Burden in Recessive Dystrophic Epidermolysis Bullosa: Implications for Preventive Monitoring"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5136-841X","authenticated-orcid":false,"given":"Luc\u00eda","family":"Quintana-Castanedo","sequence":"first","affiliation":[{"name":"Department of Dermatology, Hospital La Paz, 28046 Madrid, Spain"},{"name":"Department of Dermatology, Marqu\u00e9s de Valdecilla University Hospital, 39008 Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0374-2950","authenticated-orcid":false,"given":"Roc\u00edo","family":"Maseda","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9585-6167","authenticated-orcid":false,"given":"Silvia","family":"S\u00e1nchez-Ram\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Immunology, Hospital Cl\u00ednico San Carlos, 28040 Madrid, Spain"},{"name":"Immunology Group, Health Research Institute of the Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4601-7150","authenticated-orcid":false,"given":"Nora","family":"Butta","sequence":"additional","affiliation":[{"name":"Department of Hematology and Hemotherapy, Hospital La Paz, 28046 Madrid, Spain"},{"name":"Coagulopathies and Alterations in Haemostasis Group, IdiPAZ Health Research Institute, Hospital La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6839-1963","authenticated-orcid":false,"given":"Marta","family":"Molero-Luis","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Hospital La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3130-1922","authenticated-orcid":false,"given":"Mar\u00eda G.","family":"Crespo","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Hospital La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8306-889X","authenticated-orcid":false,"given":"Antonio","family":"Bu\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Hospital La Paz, 28046 Madrid, Spain"},{"name":"Neonatology Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0682-5225","authenticated-orcid":false,"given":"Sara","family":"Herr\u00e1iz-Gil","sequence":"additional","affiliation":[{"name":"Departamento de Bioingenier\u00eda, Universidad Carlos III de Madrid, 28911 Legan\u00e9s, Spain"},{"name":"Centro de Investigaciones Energ\u00e9ticas, Medioambientales y Tecnol\u00f3gicas (CIEMAT), 28040 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Raras (CIBERER)-ISCIII, 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Fundaci\u00f3n Jim\u00e9nez D\u00edaz (IIS-FJD, UAM), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8302-0995","authenticated-orcid":false,"given":"Carlos","family":"Le\u00f3n","sequence":"additional","affiliation":[{"name":"Departamento de Bioingenier\u00eda, Universidad Carlos III de Madrid, 28911 Legan\u00e9s, Spain"},{"name":"Centro de Investigaciones Energ\u00e9ticas, Medioambientales y Tecnol\u00f3gicas (CIEMAT), 28040 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Raras (CIBERER)-ISCIII, 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Fundaci\u00f3n Jim\u00e9nez D\u00edaz (IIS-FJD, UAM), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8329-6457","authenticated-orcid":false,"given":"Alberto","family":"Varas","sequence":"additional","affiliation":[{"name":"Immunology Group, Health Research Institute of the Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"},{"name":"Department of Cell Biology and Histology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0076-3254","authenticated-orcid":false,"given":"Lidia M.","family":"Fern\u00e1ndez-Sevilla","sequence":"additional","affiliation":[{"name":"Immunology Group, Health Research Institute of the Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"},{"name":"Department of Basic Health Sciences, Faculty of Health Sciences, University Rey Juan Carlos, 28922 Alcorc\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1267-3021","authenticated-orcid":false,"given":"Pilar","family":"Zuluaga","sequence":"additional","affiliation":[{"name":"Department of Statistics and Operations Research, Faculty of Medicine, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7587-267X","authenticated-orcid":false,"given":"Ra\u00fal","family":"de Lucas","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2910-7189","authenticated-orcid":false,"given":"Marcela","family":"del R\u00edo","sequence":"additional","affiliation":[{"name":"Departamento de Bioingenier\u00eda, Universidad Carlos III de Madrid, 28911 Legan\u00e9s, Spain"},{"name":"Centro de Investigaciones Energ\u00e9ticas, Medioambientales y Tecnol\u00f3gicas (CIEMAT), 28040 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Raras (CIBERER)-ISCIII, 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Fundaci\u00f3n Jim\u00e9nez D\u00edaz (IIS-FJD, UAM), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9456-5541","authenticated-orcid":false,"given":"\u00c1ngeles","family":"Vicente","sequence":"additional","affiliation":[{"name":"Department of Cell Biology and Histology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain"},{"name":"Stem Cells, Immunity and Cancer Group, Health Research Institute Hospital 12 de Octubre (I+12), 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5434-1885","authenticated-orcid":false,"given":"Mar\u00eda J.","family":"Esc\u00e1mez","sequence":"additional","affiliation":[{"name":"Departamento de Bioingenier\u00eda, Universidad Carlos III de Madrid, 28911 Legan\u00e9s, Spain"},{"name":"Centro de Investigaciones Energ\u00e9ticas, Medioambientales y Tecnol\u00f3gicas (CIEMAT), 28040 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Raras (CIBERER)-ISCIII, 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Fundaci\u00f3n Jim\u00e9nez D\u00edaz (IIS-FJD, UAM), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7486-7120","authenticated-orcid":false,"given":"Rosa","family":"Saced\u00f3n","sequence":"additional","affiliation":[{"name":"Immunology Group, Health Research Institute of the Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"},{"name":"Department of Cell Biology and Histology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1038\/s41572-020-0210-0","article-title":"Epidermolysis bullosa","volume":"6","author":"Bardhan","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1186\/s13023-025-04034-2","article-title":"Tissue and systemic inflammation in dystrophic epidermolysis bullosa: A systematic review and meta-analysis","volume":"20","author":"Karakioulaki","year":"2025","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e15146","DOI":"10.1111\/exd.15146","article-title":"Unveiling the value of C-reactive protein as a severity biomarker and the IL4\/IL13 pathway as a therapeutic target in recessive dystrophic epidermolysis bullosa: A multiparametric cross-sectional study","volume":"33","author":"Maseda","year":"2024","journal-title":"Exp. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.det.2010.01.004","article-title":"Infection and colonization in epidermolysis bullosa","volume":"28","author":"Mellerio","year":"2010","journal-title":"Dermatol. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/INF.0000000000003871","article-title":"Bloodstream infection in children with epidermolysis bullosa","volume":"42","author":"Quintana","year":"2023","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1016\/j.jid.2024.03.008","article-title":"Beyond the Surface: A Narrative Review Examining the Systemic Impacts of Recessive Dystrophic Epidermolysis Bullosa","volume":"144","author":"Popp","year":"2024","journal-title":"J. Investig. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s13023-025-03635-1","article-title":"Taking care of patients with recessive dystrophic epidermolysis bullosa from birth to adulthood: A multidisciplinary Italian Delphi consensus","volume":"20","author":"Diociaiuti","year":"2025","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.clnu.2019.02.023","article-title":"A nutrition-based approach to epidermolysis bullosa: Causes, assessments, requirements and management","volume":"39","author":"Salera","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_9","first-page":"1731","article-title":"Quality of life in people with epidermolysis bullosa: A systematic review","volume":"29","author":"Togo","year":"2020","journal-title":"Qual. Life Res. Int. J. Qual. Life Asp. Treat. Care Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1093\/ced\/llaf009","article-title":"Milestone events in recessive dystrophic epidermolysis bullosa: Findings of the PEBLES study","volume":"50","author":"Mellerio","year":"2025","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_11","first-page":"20","article-title":"The Natural History of Severe Recessive Dystrophic Epidermolysis Bullosa\u20134 Phases Which may Help Determine Different Therapeutic Approaches","volume":"2","author":"Bageta","year":"2021","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"De Rosa, L., Enzo, E., Palamenghi, M., Sercia, L., and De Luca, M. (2023). Stairways to Advanced Therapies for Epidermolysis Bullosa. Cold Spring Harb. Perspect. Biol., 15.","DOI":"10.1101\/cshperspect.a041229"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1016\/j.ymthe.2025.03.017","article-title":"Progress in skin gene therapy: From the inside and out","volume":"33","author":"Osborn","year":"2025","journal-title":"Mol. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/s40291-025-00804-7","article-title":"Prademagene Zamikeracel: First Approval","volume":"29","author":"Lee","year":"2025","journal-title":"Mol. Diagn. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6298","DOI":"10.1097\/MS9.0000000000001422","article-title":"Revolutionary breakthrough: FDA approves Vyjuvek, the first topical gene therapy for dystrophic epidermolysis bullosa","volume":"85","author":"Khan","year":"2023","journal-title":"Ann. Med. Surg."},{"key":"ref_16","first-page":"E15","article-title":"VYJUVEK for dystrophic epidermolysis bullosa: Ethical dilemmas in access and pricing","volume":"94","author":"Islam","year":"2025","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s10238-024-01302-6","article-title":"Role of zinc in health and disease","volume":"24","author":"Stiles","year":"2024","journal-title":"Clin. Exp. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1007\/s00204-020-02702-9","article-title":"Recent aspects of the effects of zinc on human health","volume":"94","author":"Chasapis","year":"2020","journal-title":"Arch. Toxicol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Gammoh, N.Z., and Rink, L. (2017). Zinc in Infection and Inflammation. Nutrients, 9.","DOI":"10.20944\/preprints201705.0176.v1"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Costa, M.I., Sarmento-Ribeiro, A.B., and Gon\u00e7alves, A.C. (2023). Zinc: From Biological Functions to Therapeutic Potential. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24054822"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wessels, I., Maywald, M., and Rink, L. (2017). Zinc as a Gatekeeper of Immune Function. Nutrients, 9.","DOI":"10.3390\/nu9121286"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.det.2010.01.010","article-title":"Nutrition for children with epidermolysis bullosa","volume":"28","author":"Haynes","year":"2010","journal-title":"Dermatol. Clin."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s13023-021-01811-7","article-title":"A systematic literature review of the disease burden in patients with recessive dystrophic epidermolysis bullosa","volume":"16","author":"Tang","year":"2021","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s44192-025-00209-2","article-title":"The impact of epidermolysis bullosa on quality of life and mental health","volume":"5","author":"Claure","year":"2025","journal-title":"Discov. Ment. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5404093","DOI":"10.1155\/2018\/5404093","article-title":"Zinc in Keratinocytes and Langerhans Cells: Relevance to the Epidermal Homeostasis","volume":"2018","author":"Ogawa","year":"2018","journal-title":"J. Immunol. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1374S","DOI":"10.1093\/jn\/130.5.1374S","article-title":"Overview of zinc absorption and excretion in the human gastrointestinal tract","volume":"130","author":"Krebs","year":"2000","journal-title":"J. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1111\/j.1468-3083.2004.01067.x","article-title":"Vitamin and trace metal levels in recessive dystrophic epidermolysis bullosa","volume":"18","author":"Vrillat","year":"2004","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1111\/bjd.18624","article-title":"Growth profile and anaemia in children with epidermolysis bullosa","volume":"182","author":"Laimer","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.1182\/bloodadvances.2024015271","article-title":"Interplay between iron metabolism, inflammation, and EPO-ERFE-hepcidin axis in RDEB-associated chronic anemia","volume":"9","author":"Maseda","year":"2025","journal-title":"Blood Adv."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jdin.2020.12.007","article-title":"A comparison study of outcome measures for epidermolysis bullosa: Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) and the Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (iscorEB)","volume":"2","author":"Rogers","year":"2021","journal-title":"JAAD Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.endinu.2018.05.002","article-title":"Barcelona Longitudinal Growth Study 1995\u20132017","volume":"65","author":"Carrascosa","year":"2018","journal-title":"Endocrinol. Diabetes Y Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1172\/JCI34034","article-title":"New challenges in studying nutrition-disease interactions in the developing world","volume":"118","author":"Prentice","year":"2008","journal-title":"J. Clin. Investig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/pde.15239","article-title":"Iron status and burden of anemia in children with recessive dystrophic epidermolysis bullosa","volume":"40","author":"Tarango","year":"2023","journal-title":"Pediatr. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1111\/bjd.18475","article-title":"Natural history of growth and anaemia in children with epidermolysis bullosa: A retrospective cohort study","volume":"182","author":"Reimer","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s13023-022-02448-w","article-title":"Consensus guidelines for diagnosis and management of anemia in epidermolysis bullosa","volume":"18","author":"Tarango","year":"2023","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"259","DOI":"10.5223\/pghn.2016.19.4.259","article-title":"Hair Zinc Level Analysis and Correlative Micronutrients in Children Presenting with Malnutrition and Poor Growth","volume":"19","author":"Han","year":"2016","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1179\/2046905514Y.0000000151","article-title":"Zinc deficiency in infants and children: A review of its complex and synergistic interactions","volume":"34","author":"Krebs","year":"2014","journal-title":"Paediatr. Int. Child Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1001\/archderm.1989.01670150064009","article-title":"Blood Vitamin and Trace Metal Levels in Epidermolysis Bullosa","volume":"125","author":"Fine","year":"1989","journal-title":"Arch. Dermatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nutres.2019.11.009","article-title":"Zinc and protein metabolism in chronic liver diseases","volume":"74","author":"Katayama","year":"2020","journal-title":"Nutr. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"162","DOI":"10.3164\/jcbn.23-89","article-title":"Zinc supplementation with polaprezinc was associated with improvements in albumin, prothrombin time activity, and hemoglobin in chronic liver disease","volume":"74","author":"Abiru","year":"2024","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Haynes, L. (2007). Epidermolysis Bullosa. Clinical Paediatric Dietetics, Wiley-Blackwell.","DOI":"10.1002\/9780470692004.ch24"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1524-475X.2006.00179.x","article-title":"Zinc in wound healing: Theoretical, experimental, and clinical aspects","volume":"15","author":"Lansdown","year":"2007","journal-title":"Wound Repair Regen."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Lin, P.-H., Sermersheim, M., Li, H., Lee, P., Steinberg, S., and Ma, J. (2017). Zinc in Wound Healing Modulation. Nutrients, 10.","DOI":"10.3390\/nu10010016"},{"key":"ref_44","first-page":"102","article-title":"Zinc and Wound Healing: A Review of Zinc Physiology and Clinical Applications","volume":"29","author":"Kogan","year":"2017","journal-title":"Wounds A Compend. Clin. Res. Pract."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"709152","DOI":"10.1155\/2014\/709152","article-title":"Zinc therapy in dermatology: A review","volume":"2014","author":"Gupta","year":"2014","journal-title":"Dermatol. Res. Pract."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000247982","article-title":"Percutaneous absorption of zinc from zinc oxide applied topically to intact skin in man","volume":"180","author":"Agren","year":"1990","journal-title":"Dermatologica"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Schoofs, H., Schmit, J., and Rink, L. (2024). Zinc Toxicity: Understanding the Limits. Molecules, 29.","DOI":"10.3390\/molecules29133130"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"679s","DOI":"10.3945\/ajcn.110.005744","article-title":"Zinc: An essential but elusive nutrient","volume":"94","author":"King","year":"2011","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"858s","DOI":"10.3945\/jn.115.220079","article-title":"Biomarkers of Nutrition for Development (BOND)-Zinc Review","volume":"146","author":"King","year":"2015","journal-title":"J. Nutr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1024\/0300-9831\/a000262","article-title":"The Role of Zinc in Thyroid Hormones Metabolism","volume":"89","author":"Severo","year":"2019","journal-title":"Int. J. Vitam. Nutr. Res."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Mar\u00edn de Jes\u00fas, S., Vigueras-Villase\u00f1or, R.M., Cort\u00e9s-Barberena, E., Hern\u00e1ndez-Rodriguez, J., Montes, S., Arrieta-Cruz, I., P\u00e9rez-Aguirre, S.G., Bonilla-Jaime, H., Lim\u00f3n-Morales, O., and Arteaga-Silva, M. (2024). Zinc and Its Impact on the Function of the Testicle and Epididymis. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25168991"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"23388","DOI":"10.1002\/jcp.28908","article-title":"Zinc ions increase GH signaling ability through regulation of available plasma membrane-localized GHR","volume":"234","author":"Li","year":"2019","journal-title":"J. Cell. Physiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1126\/science.1907025","article-title":"Dimerization of human growth hormone by zinc","volume":"253","author":"Cunningham","year":"1991","journal-title":"Science"},{"key":"ref_54","first-page":"881","article-title":"Positive effects of zinc supplementation on growth, GH, IGF1, and IGFBP3 in eutrophic children","volume":"25","author":"Alves","year":"2012","journal-title":"J. Pediatr. Endocrinol. Metab. JPEM"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1093\/ajcn\/75.6.1062","article-title":"Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: A meta-analysis of randomized controlled trials","volume":"75","author":"Brown","year":"2002","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1080\/07315724.2014.929511","article-title":"Effect of Zinc Supplementation on GH, IGF1, IGFBP3, OCN, and ALP in Non-Zinc-Deficient Children","volume":"34","author":"Rocha","year":"2015","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s10787-017-0309-4","article-title":"Antioxidant and anti-inflammatory effects of zinc. Zinc-dependent NF-\u03baB signaling","volume":"25","author":"Jarosz","year":"2017","journal-title":"Inflammopharmacology"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Prasad, A.S., and Bao, B. (2019). Molecular Mechanisms of Zinc as a Pro-Antioxidant Mediator: Clinical Therapeutic Implications. Antioxidants, 8.","DOI":"10.3390\/antiox8060164"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s12576-017-0571-7","article-title":"Zinc status is associated with inflammation, oxidative stress, lipid, and glucose metabolism","volume":"68","author":"Olechnowicz","year":"2018","journal-title":"J. Physiol. Sci. JPS"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/exd.12152","article-title":"Serum levels of high mobility group box 1 correlate with disease severity in recessive dystrophic epidermolysis bullosa","volume":"22","author":"Petrof","year":"2013","journal-title":"Exp. Dermatol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1080\/14728222.2018.1439924","article-title":"Extracellular HMGB1 as a therapeutic target in inflammatory diseases","volume":"22","author":"Andersson","year":"2018","journal-title":"Expert Opin. Ther. Targets"},{"key":"ref_62","first-page":"621","article-title":"Premature death and inherited epidermolysis bullosa (EB): Cumulative risk, as assessed by lifetable analysis of the national EB registry dataset","volume":"4","author":"Fine","year":"1995","journal-title":"J. Investig. Dermatol."},{"key":"ref_63","first-page":"e323\u2013329","article-title":"Prophylactic zinc supplementation reduces bacterial load and improves survival in a murine model of sepsis","volume":"13","author":"Nowak","year":"2012","journal-title":"Pediatr. Crit. Care Med. A J. Soc. Crit. Care Med. World Fed. Pediatr. Intensive Crit. Care Soc."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1093\/jn\/nxaa444","article-title":"Associations between Zinc and Hemoglobin Concentrations in Preschool Children and Women of Reproductive Age: An Analysis of Representative Survey Data from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project","volume":"151","author":"Greffeuille","year":"2021","journal-title":"J. Nutr."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.3945\/jn.116.235127","article-title":"Serum Zinc Is a Major Predictor of Anemia and Mediates the Effect of Selenium on Hemoglobin in School-Aged Children in a Nationally Representative Survey in New Zealand","volume":"146","author":"Houghton","year":"2016","journal-title":"J. Nutr."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Jeng, S.S., and Chen, Y.H. (2022). Association of Zinc with Anemia. Nutrients, 14.","DOI":"10.3390\/nu14224918"},{"key":"ref_67","first-page":"e3811","article-title":"Association of Zinc Deficiency with Iron Deficiency Anemia and its Symptoms: Results from a Case-control Study","volume":"1","author":"Abdelhaleim","year":"2019","journal-title":"Cureus"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Kim, J., Lee, J., and Ryu, M.-S. (2023). Cellular Zinc Deficiency Impairs Heme Biosynthesis in Developing Erythroid Progenitors. Nutrients, 15.","DOI":"10.3390\/nu15020281"},{"key":"ref_69","first-page":"650","article-title":"Role of Zinc and Copper in Erythropoiesis in Patients on Hemodialysis","volume":"32","author":"Takahashi","year":"2022","journal-title":"J. Ren. Nutr. Off. J. Counc. Ren. Nutr. Natl. Kidney Found."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1080\/07315724.1999.10718861","article-title":"Zinc and IGF-I Concentrations in Pregnant Women with Anemia before and after Supplementation with Iron and\/or Zinc","volume":"18","author":"Nishiyama","year":"1999","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Kondaiah, P., Yaduvanshi, P.S., Sharp, P.A., and Pullakhandam, R. (2019). Iron and Zinc Homeostasis and Interactions: Does Enteric Zinc Excretion Cross-Talk with Intestinal Iron Absorption?. Nutrients, 11.","DOI":"10.3390\/nu11081885"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"5603","DOI":"10.1007\/s12011-025-04589-y","article-title":"Association of Higher Intakes of Dietary Zinc with Higher Ferritin or Hemoglobin: A Cross-sectional Study from NHANES (2017\u20132020)","volume":"203","author":"Abdi","year":"2025","journal-title":"Biol. Trace Element Res."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Sato, E., Sato, S., Degawa, M., Ono, T., Lu, H., Matsumura, D., Nomura, M., Moriyama, N., Amaha, M., and Nakamura, T. (2022). Effects of Zinc Acetate Hydrate Supplementation on Renal Anemia with Hypozincemia in Hemodialysis Patients. Toxins, 14.","DOI":"10.3390\/toxins14110746"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1093\/ajcn\/85.5.1301","article-title":"Trace element supplementation after major burns increases burned skin trace element concentrations and modulates local protein metabolism but not whole-body substrate metabolism","volume":"85","author":"Berger","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s41038-017-0076-x","article-title":"Nutrition and metabolism in burn patients","volume":"5","author":"Clark","year":"2017","journal-title":"Burn. Trauma"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"537","DOI":"10.3390\/ebj4040035","article-title":"Nutrition Considerations for Burn Patients: Optimizing Recovery and Healing","volume":"4","author":"Shields","year":"2023","journal-title":"Eur. Burn. J."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Maares, M., and Haase, H. (2020). A Guide to Human Zinc Absorption: General Overview and Recent Advances of In Vitro Intestinal Models. Nutrients, 12.","DOI":"10.3390\/nu12030762"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"89-97.e1-13","DOI":"10.1016\/j.jaad.2013.09.041","article-title":"Development, reliability, and validity of a novel Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI)","volume":"70","author":"Loh","year":"2014","journal-title":"J. Am. Acad. 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