Correlation between Zinc Intake and Zinc Serum Levels with C-reactive Protein Level in Head and Neck Cancer Patients

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Muningtya Philiyanisa Alam
Diana Sunardi
Ikhwan Rinaldi


The inflammatory process of head and neck cancer leads to an increase the proinflammatory cytokines and the synthesis of c-reactive protein (CRP), which then causes metabolic alteration and anorexia in the patients. Zinc is one of  nutrient that has an important role in suppressing inflammation, but it is reported that about 65% of head and neck cancer patients have zinc deficiency. The aim of this cross sectional study is to determine the correlation between zinc intake and serum zinc levels with CRP level as an effort in reducing inflammation process in head and neck cancer patients. Subjects were collected by consecutive sampling in the Oncology Polyclinic Rumah Sakit Kanker Dharmais, from 49 subjects 67,3% were men, most subjects were in the age range between 46–65 years. The highest frequency (65,3%) is nasopharyngeal cancer and 69,4% are already in stage IV. All subjects (100%) in this study have a zinc intake below the recommended dietary allowance (RDA) in Indonesia. The mean serum zinc level of the subjects was 9.83±2.62 μmol/L. Most subjects have elevated CRP levels. There was a weak negative correlation between zinc concentration and CRP levels of subjects (r =-0.292, p =0.042), but there was no correlation between zinc intake and CRP levels of subjects (r =-0.25).


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Author Biographies

Muningtya Philiyanisa Alam, Universitas Indonesia

Clinical Nutrition Department

Diana Sunardi, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital

Department of Nutrition

Ikhwan Rinaldi, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital

Hematology-Oncology Division, Department of Internal Medicine


Everett EV. Head and Neck Cancer. In: Harrison’s Principles of Internal medicine. 18th edition. USA: The Mc-Graw Hill Companies; 2012. [Google Scholar]

Argiris A, Eng C. Epidemiology, Staging, and Sreening of Head and Neck Cancer. In: Head and Neck Cancer. USA: Kluwer Academic Publishers; 2004. [Google Scholar]

Boyle P, Levin B, editor. World Cancer Report 2008. International Agency for Research on Cancer. World Health Organization; 2008.

Muliawati Y, Haroen H, Rotty LWA. Cancer anorexia - cachexia syndrome. Acta Medica Indones 2012;44:154. [Google Scholar]

Prasad AS, Bao B, Beck FWJ, Sarkar FH. Zinc-suppressed inflammatory cytokines by induction of A20-mediated inhibition of nuclear factor-κB. Nutrition 2011;27:816. [Google Scholar]

Skipworth RJE, Stewart GD, Dejong CHC, Preston T, Fearon KCH. Pathophysiology of cancer cachexia: Much more than host–tumour interaction. Clin Nutr 2007;26:667. [Google Scholar]

Allin KH, Nordestgaard BG. Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci 2011;48:155. [Google Scholar]

Prasad AS, Beck FW, Snell DC, Kucuk O. Zinc in cancer prevention. Nutrition and cancer 2009 Nov;61(6):879-87. [Google Scholar]

Irene . Kadar seng serum pada pasien kanker kepala dan leher serta hubungannya dengan status radiasi (tesis. Jakarta: Universitas Indonesia; 2012. [Google Scholar]

Garofalo JA, Erlandson E, Strong EW, Lesser M, Gerold F, Spiro R, et al. Serum zinc, serum copper, and the Cu/Zn ratio in patients with epidermoid cancers of the head and neck. J Surg Oncol 1980;15:381. [Google Scholar]

Abdulla M, Biörklund A, Mathur A, Wallenius K. Zinc and copper levels in whole blood and plasma from patients with squamous cell carcinomas of head and neck. J Surg Oncol 1979;12:107. [Google Scholar]

Mahdavi R, Faramarzi E, Mohammad-Zadeh M, Ghaeammaghami J, Jabbari MV. Consequences of radiotherapy on nutritional status, dietary intake, serum zinc and copper levels in patients with gastrointestinal tract and head and neck cancer. Saudi Med J 2007;28:435. [Google Scholar]

Foster M, Samman S. Zinc and regulation of inflammatory cytokines: implications for cardiometabolic disease. Nutrients 2012;4:676. [Google Scholar]

Bao B, Ahmad A, Azmi AS, Wang Z, Banerjee S, Sarkar FH. The Protective Role of Zinc in Cancer: A Potential Chemopreventive Agent. In: Shankar S, Srivastava RK, editors. Nutrition, Diet and Cancer. Springer Netherlands; 2012. [Google Scholar]

Permenkes Tentang Angka Kecukupan Gizi [Internet]. Gizinet. [cited 2015 Oct 24]. Available from:

Westin T, Ahlbom E, Johansson E, Sandström B, Karlberg I, Edström S. Circulating levels of selenium and zinc in relation to nutritional status in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 1989;115:1079. [Google Scholar]

Sattar N, Scott HR, McMillan DC, Talwar D, O’Reilly DS, Fell GS. Acute-phase reactants and plasma trace element concentrations in non-small cell lung cancer patients and controls. Nutr Cancer 1997;28:308. [Google Scholar]

Siren PM. Siren MJ. Systemic zinc redistribution and dyshomeostasis in cancer cachexia. J Cachexia Sarcopenia Muscle 2010;1:23. [Google Scholar]

Chen HH, Wang HM, Fan KH, Lin CY, Yen TC, Liao CT, Chen IH, Kang CJ, Huang SF. Pre-treatment levels of C-reactive protein and squamous cell carcinoma antigen for predicting the aggressiveness of pharyngolaryngeal carcinoma. PloS one. 2013 Jan 31;8(1):e55327.

Aref H, Refaat S. CRP evaluation in non-small cell lung cancer. Egypt J Chest Dis Tuberc 2014;63:717. [Google Scholar]