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Contents lists available at ScienceDirect

Journal of Trace Elements in Medicine and Biology

journal homepage: www.elsevier.de/jtemb

Physiology

Short-term weight loss in overweight/obese low-income women improves

plasma zinc and metabolic syndrome risk factors
Venkata Saroja Voruganti a,∗ , Guowen Cai b , Deborah M. Klohe c , Kristine C. Jordan d ,
Michelle A. Lane e , Jeanne H. Freeland-Graves c
a
Department of Genetics, Southwest Foundation for Biomedical Research, San Antonio, TX 78227, United States
b
SAS Institute, 100 SAS Campus Drive, Cary, NC 27513-2414, United States
c
Department of Nutritional Sciences, The University of Texas at Austin, Austin 78712, United States
d
Division of Nutrition, University of Utah College of Health, Salt Lake City, UT 84112, United States
e
Nutrition and Foods Program, Department of Family and Consumer Sciences, Texas State University, San Marcos, TX 78666, United States

a r t i c l e i n f o a b s t r a c t

Article history: Metabolic syndrome is a group of disorders involving obesity, insulin resistance, dyslipidemia and hyper-
Received 2 November 2009 tension. Obesity is the most crucial risk factor of metabolic syndrome, because it is known to precede
Accepted 19 May 2010 other risk factors. Obesity is also associated with disturbances in the metabolism of the trace mineral,
zinc. The overall purpose of this study was to investigate the effects of short-term weight loss on plasma
Keywords: zinc and metabolic syndrome risk factors. An 8-week weight loss intervention study was conducted with
Obesity
90 low-income overweight/obese mothers, whose youngest child was 1–3 years old. Plasma levels of zinc,
Intervention
glucose, insulin, leptin, triglycerides, total, high-density lipoprotein (HDL) and low-density lipoprotein
Body fat
(LDL) cholesterol were measured and compared at weeks 0 and 8 of the weight loss program. At pre-
study, plasma zinc was low in 39% and, within normal values in 46%, of obese/overweight mothers. By the
end of intervention, plasma zinc rose by 22% and only 5% of the mothers continued to exhibit low plasma
zinc. At post-study, the metabolic syndrome risk factors of waist circumference, HDL cholesterol, and
diastolic blood pressure (p < 0.05) showed significant improvements. Plasma zinc increased by a greater
margin (67%) in women with low zinc, as compared to those with normal zinc (18%); weight reduction
was similar in both the groups. Finally, changes in % body fat were related negatively with changes in
plasma zinc (r = − 0.28, p < 0.05). The circulating levels of zinc, as well as the metabolic syndrome com-
ponents, showed significant improvements in overweight/obese low-income women after weight loss.

© 2010 Elsevier GmbH. All rights reserved.

Introduction
Metabolic syndrome is a group of disorders involving obesity,
insulin resistance, dyslipidemia and hypertension [1]. This condi-
tion affects about 35% of adults in the United States (US) [2]. An
earlier study by Ford [3] found the prevalence of metabolic syn-
drome in US adults to be approximately 27%, an increase of 16%
since 1994 [3]. This escalation is particularly alarming for women,
because they showed a greater increase (23.5%) than men (2.2%)
[3].
According to the National Cholesterol Education Program-Adult
Treatment Panel (NCEP ATP III), metabolic syndrome is charac-
terized by the presence of at least three of the following risk
∗ Corresponding author at: Department of Genetics, Southwest Foundation for
Biomedical Research, PO Box 760549, San Antonio, TX 78245, United States.
Tel.: +1 210 258 9795; fax: +1 210 258 9132.
E-mail address: svorugan@sfbrgenetics.org (V.S. Voruganti).
factors; waist circumference > 88 cm for women and > 102 cm for
men, fasting glucose > 100 mg/dl, fasting triglycerides > 150 mg/dl,
HDL cholesterol < 50 mg/dl for women and < 40 mg/dl for men, and
blood pressure > 130/85 mm Hg [4]. Although metabolic syndrome
is considered to be the combined effect of all these risk factors,
each individual component is known to independently augment
the risk of associated diseases such as cardiovascular disorders and
type 2 diabetes [5]. The recent escalation in metabolic syndrome
incidence has been attributed to obesity [2], the most crucial risk
factor of this syndrome [6].
The prevalence of obesity has been escalating rapidly; in
2007–2008 the age adjusted prevalence of obesity was 33.8% [7].
Also, obesity is widespread in women, predominantly in those who
are low-income [8] and minority [9]. Metabolic syndrome and obe-
sity are associated with several metabolic disturbances, one of
them being alterations in the metabolism of trace minerals such
as zinc [10]. Zinc status, particularly circulating level, is known
to be altered in conditions such as obesity and type 2 diabetes,
as observed in animal [11–13] as well as human [14–16] models.

0946-672X/$ – see front matter © 2010 Elsevier GmbH. All rights reserved.
doi:10.1016/j.jtemb.2010.05.001

Please cite this article in press as: Voruganti VS, et al. Short-term weight loss in overweight/obese low-income women improves plasma
zinc and metabolic syndrome risk factors. J Trace Elem Med Biol (2010), doi:10.1016/j.jtemb.2010.05.001
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Specifically, plasma zinc has been observed to be low in obese chil-
dren and adolescents [15,16], adult men and women [17–20], and
obese mice [21].
Zinc, a trace element, is required for several cellular functions
and participates in important metabolic pathways related to the
metabolism of proteins, carbohydrates, lipids and nucleic acids
[16,22]. Zinc deficiency has several features in common with insulin
resistance, hyperglycemia, and impaired glucose tolerance [10] and
may lead to the development of diabetes [23]. The influence of zinc
on glucose metabolism may be related to its insulin-like properties.
For example, zinc promotes lipogenesis and glucose transport in rat
adipocytes [24] and glucose uptake in mouse skeletal muscle [25].
Moreover, zinc may be involved in insulin signaling by forming a
complex with insulin and increasing the ability of insulin to bind
to its receptor [16]. Thus, it is conceivable that zinc may play a role
in the metabolic syndrome.
Weight loss is an effective treatment for the metabolic syndrome
[26] as it has been shown to improve blood pressure and plasma
concentrations of glucose, insulin and lipids [27]. Additionally,
plasma zinc also increases with weight loss. Specifically, plasma
zinc levels increased and returned to normal levels in obese patients
who were fed hypocaloric diets [19,28]. In contrast, morbidly obese
patients undergoing a Roux-en-Y gastric bypass surgery did not
have attenuations in plasma zinc with weight loss [20]. There-
fore, the effect of weight loss on circulating zinc levels remains
controversial. In the current study, the primary objective was to
investigate the effect of short-term weight loss on circulating zinc
levels. The secondary aim was to confirm the positive effects of
weight loss on metabolic syndrome risk factors.
Material and methods
Design
An 8-week weight loss intervention study was conducted with
90 overweight or obese, (body mass index (BMI) ≥ 25 kg/m2 ) low-
income mothers. All participants were administered a 33-item
demographic questionnaire at week 0. Details of the intervention
have been given in Klohe-Lehman et al. [29]. In short, anthropo-
metric variables (body weight, waist circumference, percent body
fat, BMI, blood pressure) were obtained at weeks 0 and 8. Blood
was collected after a 12-h fasting period; plasma was extracted and
stored at −80 ◦ C until further analysis. Plasma levels of zinc, glucose,
insulin, leptin, triglycerides, total and high-density lipoprotein
(HDL) and low-density lipoprotein (LDL) cholesterol were mea-
sured at weeks 0 and 8.
Subjects
Selection criteria included: age, 18–45 years; youngest child,
1–3 years; Hispanic, Caucasian or African-American ethnicity;
English literacy; eligibility for WIC or Medicaid; and income < 200%
of the federal poverty index. The ethnicity of the participants was
63% Hispanic, 19% African-American and 18% Caucasian. The nature
of the risks and benefits of the study were explained to the partic-
ipants, and informed consent was given. The Institutional Review
Board of The University of Texas at Austin approved this study.
Anthropometric measurements
Height was measured in inches using a stadiometer (Perspective
Enterprises, Portage, MI). Weight was determined with an elec-
tronic scale (Model HS-100-A, Fairbanks Scales, St. Johnsbury, VT).
Waist circumference was obtained by positioning a measuring tape
around the abdomen at the highest lateral border on the right
ilial crest, as recommended by NHANES III (National Heart Lung
Please cite this article in press as: Voruganti VS, et al. Short-term weight loss in overweight/obese low-income women improves plasma
zinc and metabolic syndrome risk factors. J Trace Elem Med Biol (2010), doi:10.1016/j.jtemb.2010.05.001
and Blood Institute 1998). Percent body fat was estimated by bio-
electric impedance (Model TBF-300A, Tanita Corporation, Arlington
Heights, IL). Body mass index (BMI, kg/m2 ) was calculated by divid-
ing body weight in kilograms by height in meters squared. Systolic
and diastolic blood pressures were measured with sphygmamome-
ter (Model Marshall Medical, Placerville, CA).
Biochemical measurements
Plasma zinc was determined by a flame atomic absorption spec-
trophotometer (5100PC, Perkin Elmer Corporation, Shelton, CT)
[30]. Plasma glucose was analyzed by a glucometer (Glucome-
ter Elite, Bayer Corporation, Elkhart, IN). Plasma concentrations
of insulin and leptin were measured using a commercial enzyme-
linked immunoabsorbent assay kit (ALPCO, Windham, NH). Lipids,
including triglycerides, total and HDL cholesterol were obtained
enzymatically (Sigma Diagnostics Inc., St. Louis, MO). The Freid-
wald formula was used to estimate LDL cholesterol [31]. Insulin
sensitivity was calculated by the Quicki method [32] and insulin
resistance was computed by the homoeostatic model assessment
method (HOMA) [33]. The prevalence of metabolic syndrome was
evaluated in these mothers, based on the criteria given in the NCEP
ATP III panel [4].
Statistical analyses
Statistical package for social sciences (SPSS, version 10.0; SPSS
Inc., Chicago, USA) was used for all statistical analyses. Descrip-
tives (means, standard deviation and range) were computed for
both anthropometric and biochemical parameters. Relationships
between zinc and other metabolic syndrome risk factors were
tested using Pearson’s correlation between anthropometric and
biochemical measurements. Analysis of variance (ANOVA) with
post hoc Scheffe analysis was used to determine significant differ-
ences between three or more subject groups. All differences were
considered to be significant at p < 0.05.
Results
At pre-study, all mothers were premenopausal and their ages
ranged from 18 to 42 years (mean 27.6 ± 0.6 years). Based on
BMI, 22% were overweight (BMI 25–29.99 kg/m2 ), 56% obese (BMI
30–39.99 kg/m2 ) and 22% were morbidly obese (BMI ≥ 40 kg/m2 ).
At baseline, plasma zinc was low in 39% (<0.8 mg/l) and within
normal values in 46% (0.8–1.2 mg/l) of mothers. Mothers in both
groups (low vs. normal zinc) had comparable BMIs at the start of the
study. For metabolic syndrome risk factors, 88% had elevated waist
circumference; 67%, high fasting glucose; 29%, enhanced triglyc-
erides; and 88%, low HDL cholesterol.
Moderate weight loss increased plasma zinc following
intervention in low-income women
At the start of this study, 39% of mothers had low plasma zinc
(<0.8 mg/dl). After the 8-week intervention period, plasma zinc rose
by 22% during the intervention. At the end of the study, only 5%
of the mothers continued to exhibit low plasma zinc. Weight loss
was similar in mothers with low zinc at baseline versus those who
exhibited normal zinc at baseline.
Moderate weight loss improved metabolic syndrome risk factors
following intervention in low-income women
A moderate weight loss of ∼2.3 kg (2.5%) was observed in moth-
ers after an 8-week intervention program. This weight loss ranged
from 0 to 11.5 kg. Pre- and post-study characteristics (Table 1)
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Table 1
Pre- and post-study descriptive characteristics of participating mothers.

Characteristics Pre-studya Post-studya P-value

b
BMI (kg/m ) 2
35.4 ± a
0.8 34.6 ± a
0.8 <0.001
Body fat (%) 43.2 ± 0.7 42.1 ± 0.7 <0.001
Leptin (ng/ml) 18.3 ± 1.09 18.9 ± 1.1 NS
Insulin (IU/l) 13.0 ± 1.2 14.7 ± 01.6 NS
HOMAc IR 4.0 ± 0.7 3.6 ± 0.42 NS
Cholesterol (mg/dl)
Total 166 ± 4.1 158 ± 3.3 <0.05
LDLd 103 ± 4.1 87.2 ± 4.4 <0.01
Zinc (mg/l) 0.85 ± 0.04 1.04 ± 0.02 <0.001

Metabolic syndrome risk factors

Waist circumference (cm) 107 ± 2.0 104.7 ± 1.9 <0.001
Glucose (mg/dl) 112 ± 4.8 106.8 ± 4.9 NS
Triglycerides (mg/dl) 123.7 ± 7.0 115.8 ± 3.3 NS
HDLe cholesterol (mg/dl) 38.7 ± 1.2 52.3 ± 3.4 <0.0001
Blood pressure (mm Hg)
Systolic 118 ± 1.4 116 ± 1.4 NS
Diastolic 77.6 ± 1.1 75.7 ± 0.9 <0.05
a
Mean ± SEM.
b
Body mass index.
c
Homeostatic model assessment method (Mathews et al. [33]).
d
Low-density lipoprotein.
e
High-density lipoprotein. Fig. 2. Relationship of changes in dietary intakes of energy and zinc.

Changes in dietary zinc were positively associated with reduction

show significant decreases in BMI, percent body fat, BMI, total, and
LDL cholesterol, waist circumference and diastolic blood pressure
and increase in HDL cholesterol and plasma zinc. No change was
observed in plasma leptin, insulin or systolic blood pressure. The
decreases in plasma glucose and triglyceride following intervention
were not statistically significant. At the pre-intervention stage, 53%
of the participants had metabolic syndrome; whereas, only 19% of
the mothers exhibited this syndrome at post-intervention.
Changes in body fat were associated negatively with changes in
plasma zinc
The relationship between changes in % body fat and plasma zinc
is depicted in Fig. 1. These data show a decrease of 2.4% in body fat,
which was associated with an increase in circulating zinc (r2 = −
0.28, p < 0.05).
in energy intake
Energy and zinc intakes were evaluated pre- and post-
intervention. Mean (SE) energy intake declined from 2007 (49 kcal
at week 0 to 1465 [46] kcal, p < 0.001) at week 8. Concomitantly,
dietary zinc decreased by ∼20% during the 8-week period [mean
(SE) at week 0 = 9.22 (0.3) mg] as compared to week 8 [mean
(SE) = 7.43 (0.3) mg] p < 0.0001. The reduction in energy intake
was significantly correlated with change in dietary zinc (r2 = 0.42,
p < 0.0001) (Fig. 2).
Mothers differed in their response to weight loss based on their
baseline plasma zinc status
Fig. 3 depicts the prevalence of metabolic syndrome risk factors
at pre- and post-study, in mothers with low and normal zinc lev-
els at baseline. At baseline, mothers with low zinc exhibited greater
waist circumference and percent body fat, and higher plasma levels
of glucose, insulin, triglycerides and LDL cholesterol as compared
to those with normal zinc; however these differences were not sta-
tistically significant (p > 0.05). Although weight loss was similar in
both groups, mothers with low zinc at baseline showed a significant
decrease in waist circumference and plasma glucose than mothers
who had normal zinc at baseline. Plasma zinc levels increased in
both groups; interestingly the increase was more pronounced in
mothers with low baseline zinc than others. Percent body fat, body
mass index and HDL cholesterol showed similar improvements in
both groups (Fig. 3).

Discussion

A modest reduction in weight and metabolic risk factors is

Fig. 1. Relationship of changes in % body fat and changes in plasma zinc.
known to dramatically enhance well-being and improve health sta-
tus [34]. In addition, moderate weight loss can improve glycemic
control and insulin sensitivity in type 2 diabetic patients and pre-
vent the progression to diabetes in patients who are at high risk.
In the current study, small weight loss normalized plasma zinc and
diminished risk factors for metabolic syndrome. Specifically, lower
zinc levels at pre-intervention were associated with greater post-
intervention decreases in plasma glucose and blood pressure, as
well as increased HDL and plasma zinc. This response is encourag-

Please cite this article in press as: Voruganti VS, et al. Short-term weight loss in overweight/obese low-income women improves plasma
zinc and metabolic syndrome risk factors. J Trace Elem Med Biol (2010), doi:10.1016/j.jtemb.2010.05.001
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Fig. 3. Metabolic risk factors at pre- and post-study in mothers with baseline low and normal plasma zinc. Black and white bars indicate pre- and post-study measurements,
respectively.

ing, as many individuals find it difficult to lose substantial amounts and foremost therapy that should be adopted for treating this
of weight. condition, followed by treatment of individual components of the
Metabolic syndrome is a complex, multifactorial disorder, with syndrome [35]. In the present study a modest weight loss of 2.5%
obesity being the primary risk factor. Thus weight loss is the first occurred. However, this minimal weight loss reduced the incidence

Please cite this article in press as: Voruganti VS, et al. Short-term weight loss in overweight/obese low-income women improves plasma
zinc and metabolic syndrome risk factors. J Trace Elem Med Biol (2010), doi:10.1016/j.jtemb.2010.05.001
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of metabolic syndrome by one-third. Beneficial changes also were
observed in individual risk factors such as waist circumference, cir-
culating glucose, triglycerides and HDL cholesterol. For comparison
the prevalence of metabolic syndrome was decreased by 59% after
a weight loss of 8.2 kg (∼8%) in older obese adults [36]. However,
more modest weight losses also have been reported to improve
metabolic risk factors. A study conducted by Lofgren et al. [37]
found that a 5% weight loss reversed metabolic syndrome in seven
out of eight premenopausal women.
Low plasma zinc levels have been observed in obese [19,28],
type 2 diabetic [22] and obese-type 2 diabetic individuals [14,38].
Similarly, low plasma zinc (<0.8 mg/dl) was observed in 39% of the
overweight/obese women in the current study. Ninety percent of
these values returned to normal with weight loss. Woodhouse et
al. [19] also found a rise in plasma zinc (7%), with a 5.9% decrease
in weight of men and women fed a high dairy hypocaloric diet for
12 weeks. Similarly, Di Martino et al. [17] reported elevated plasma
zinc of 16% in men and 33% in women whose BMI had declined by
an average of 15% decline. In a Japanese weight loss program based
on hypocaloric diets, weight loss was associated with increased
plasma zinc [28]. The same response has been observed in obese
children and adolescents; plasma zinc escalated by 12% after 10
weeks of consuming a very low calorie diet [15]. In contrast, one
1987 study by Brighenti et al. did not show any improvement in
plasma zinc status with weight loss in obese subjects [39]. In the
present study, plasma zinc was elevated by about 9% for every 1%
of the body weight lost. Whether or not plasma zinc levels return to
low baseline concentrations with time merits further investigation.
In this paper, an increase in plasma zinc was associated with a
decrease in % body fat. This increase was not reflective of diet, as
dietary levels of zinc declined by 20%; this decline presumably was
due to the reduction in calories that occurred as a consequence of
dieting. In another study, women judo athletes undergoing physi-
cal training, plasma zinc was inversely associated with % body fat
as also observed in our research [40]. In a cross-sectional study
in Indian men, higher body fat percent was associated with lower
concentrations of plasma zinc [41]. In normal weight humans, zinc
deficiency also was observed in conjunction with low concentra-
tions of leptin, a hormone produced in adipose tissue. In obese men
(n = 5), Chen et al. [42] reported an inverse relationship between
levels of zinc and leptin. In contrast, a positive relationship was
reported between plasma zinc and leptin in male athletes [43].
However, no association was observed between plasma level of lep-
tin and zinc in the current study. These conflicting results may be
due to differences in sample size, age, sex and type of adiposity and
physical activity.
Disturbances in zinc concentrations (both circulating and tissue)
have been reported in obesity and insulin resistance. In a random-
ized placebo-controlled, cross-over study in 60 obese children, zinc
supplementation significantly attenuated plasma levels of glucose
and insulin and HOMA [44]. Assiri et al. observed that women with
metabolic syndrome had lower levels of plasma zinc, as compared
to women without metabolic syndrome [45]. On the other hand,
men and women with metabolic syndrome were found to be at a
higher risk for zinc deficiency, although no statistical correlation
was found between plasma zinc and metabolic syndrome compo-
nents [46].
In the current study women with low plasma zinc had higher
body weight, waist circumference, plasma glucose and % body
fat than those with normal levels of this trace mineral. This is
notable since all these traits are directly or indirectly related to
metabolic syndrome. Improvements in these metabolic risk fac-
tors were more pronounced in women with low zinc than those
with normal zinc, despite similar reductions in weight. In addition,
women with lower plasma zinc concentration at baseline exhibited
greater increases in plasma zinc. This outcome suggests that differ-
Please cite this article in press as: Voruganti VS, et al. Short-term weight loss in overweight/obese low-income women improves plasma
zinc and metabolic syndrome risk factors. J Trace Elem Med Biol (2010), doi:10.1016/j.jtemb.2010.05.001
5
ent homeostatic adjustments in zinc metabolism maybe dependent
on initial zinc status or related factors, rather than just weight loss
alone.
A limitation is the short duration of the present research. In a
more extended period of time, it would have been advantageous
to confirm the research findings but this was precluded by cost
and subject availability. Although studies reported here have used
plasma zinc to assess body zinc status, its reliability as an indicator
of zinc status is subject to debate. Nonetheless, a systematic review
of methods of zinc assessment in humans concluded that plasma
zinc, if collected and stored properly, could be a reliable indicator
of body zinc status [47]. Thus the changes observed in plasma zinc
might be a reflection of changes in body zinc status [48].
In summary, at pre-study 53% of the overweight or obese low-
income women exhibited risk factors for metabolic syndrome, and
39% had low concentrations of plasma zinc. The circulating levels of
zinc, as well as the metabolic syndrome components, showed sig-
nificant improvements in overweight or obese low-income women.
These results suggest that even a moderate weight loss can confer
health benefits, irrespective of the initial weight status.
Acknowledgement
This research is supported by a grant from the Texas Higher
Education Coordinating Board, Austin, TX (UTA #00-377).
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