An increasing recognition has emerged of the complexities of the global health agenda—specifically, the collision of infections and noncommunicable diseases and the dual burden of over- and undernutrition. Of particular practical concern are both 1) the need for a better understanding of the bidirectional relations between nutritional status and the development and function of the immune and inflammatory response and 2) the specific impact of the inflammatory response on the selection, use, and interpretation of nutrient biomarkers. The goal of the Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE) is to provide guidance for those users represented by the global food and nutrition enterprise. These include researchers (bench and clinical), clinicians providing care/treatment, those developing and evaluating programs/interventions at scale, and those responsible for generating evidence-based policy. The INSPIRE process included convening 5 thematic working groups (WGs) charged with developing summary reports around the following issues: 1) basic overview of the interactions between nutrition, immune function, and the inflammatory response; 2) examination of the evidence regarding the impact of nutrition on immune function and inflammation; 3) evaluation of the impact of inflammation and clinical conditions (acute and chronic) on nutrition; 4) examination of existing and potential new approaches to account for the impact of inflammation on biomarker interpretation and use; and 5) the presentation of new approaches to the study of these relations. Each WG was tasked with synthesizing a summary of the evidence for each of these topics and delineating the remaining gaps in our knowledge. This review consists of a summary of the INSPIRE workshop and the WG deliberations.

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Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE)

Objective Patients who have undergone Roux-en-Y gastric bypass (RYGB) for clinically severe obesity often report an aversion to sweet foods and meat. This study was designed to determine whether changes in taste acuity occur after RYGB. Design This prospective, repeated measures trial evaluated acuity for sweet (sucrose) and bitter (urea) tastes, zinc status, and reported changes in taste perceptions in patients undergoing RYGB for weight reduction. Subjects Taste acuity and serum zinc level were measured in 14 subjects, 6 men and 8 women (mean preoperative body mass index [calculated as kg/m 2 ]=60.8±11.8 and mean age=38.4±6 years), before surgery and 6 and 12 weeks after surgery. Inquiries regarding taste preferences were made at each postoperative visit with specific reference to sweets and meat. Serum zinc level was measured at the same visit. A noncontrolled comparison group of 4 subjects who were consuming a very-low-calorie diet also underwent taste acuity testing at similar intervals. Main outcome measures The main outcome measures were recognition taste thresholds, serum zinc levels, and taste preference changes. Statistical analysis Analysis of variance with repeated measures over time, Pearson correlation coefficients, and post hoc analysis of variance were used to analyze data. Results Mean recognition thresholds for sucrose were 0.047±0.03mol/L preoperatively and fell significantly to 0.024±0.01 and 0.019±0.01mol/L at 6 and 12 weeks postoperatively, respectively. Overall, there were no significant differences in taste thresholds for urea over time; a significant difference was noted, however, in the pattern of change for urea between patients who reported an aversion to meats and those who did not. Zinc concentrations did not change during the study. Application/conclusions At 6 weeks postoperatively, all patients reported that foods tasted sweeter, and they modified food selection accordingly. Six patients reported an aversion to meats associated with increased nausea and vomiting. Acuity for sweet and bitter tastes may need to be considered when planning dietary modifications for patients undergoing RYGB. J Am Diet Assoc. 1995; 95:666-670 .

Changes in Patients’ Taste Acuity after Roux-en-Y Gastric Bypass for Clinically Severe Obesity

The development of acute and chronic inflammatory processes induces, in the laboratory animal, a net accumulation of both copper and zinc in many body compartments, the inflammed area included. In rheumatoid arthritis, as well as in animal models, only plasma zinc concentration seems to be significantly correlated with disease severity, while the increase in total plasma copper could be described as an “all or nothing” phenomenon. Moreover, in rheumatoid arthritis, it appears that the disease develops and progresses without being linked to either copper or zinc deficiency conditions.

Copper and zinc body levels in inflammation: an overview of the data obtained from animal and human studies.

Recent studies on pathogenic streptococci have revealed that zinc is a pivotal metal ion in their interaction with the host. In these streptococci, systems exist that ensure optimal use of zinc from the surrounding milieu, as well as export of zinc when concentrations exceed tolerance levels. Zinc uptake is of crucial importance for the virulence of streptococci, whereas elevated zinc levels induced in the host during infection are detrimental for these pathogens. The expression or activity of a number of putative surface proteins and virulence factors depends on zinc. Moreover, several metal sensor proteins that mediate the transcriptional response to zinc in streptococci have recently been characterized. A number of components of zinc- and other metal ion-acquisition systems are suitable as protective antigens and may be future targets for the development of new vaccines, thus providing opportunities for the development of novel therapies. This review will discuss the recent advancements in the important field of metal ion biology in relation to the virulence of pathogenic streptococci, with a central focus on zinc homeostasis in Streptococcus pneumoniae.

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The role of zinc in the interplay between pathogenic streptococci and their hosts.

Though far more common, particularly in elderly people, than was previously assumed, marginal zinc deficiency does not lead to the classical manifestations of zinc deficiency and is therefore difficult to diagnose. There is therefore a need for sensitive parameters that can reliably demonstrate even marginal zinc deficiency, as suboptimal zinc status can seriously impair human health, performance, reproductive functions, and mental and physical development. The most important criteria for the diagnosis of zinc deficiency are critically discussed. The laboratory parameters currently considered to be the most useful indicators of marginal zinc deficiency are zinc-binding capacity and serum/plasma alkaline phosphatase activity before and after zinc supplementation (zinc tolerance test!). In order to obtain a reliable assessment of a patients zinc status, a number of different diagnostic parameters should always be measured.

Jean-Philippe Praet

Papers

Interest of zinc determination in leucocyte fractions for the assessment of marginal zinc status.