Prevalence of Systemic Inflammation and Micronutrient Imbalance in Patients with Complex Abdominal Hernias

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2013 Dec 21

PMID 24356980

Citations 3

Authors

Abby K Geletzke

John M Rinaldi

Brett E Phillips

Sarah B Mobley

Jamie Miller

Thomas Dykes

Christopher Hollenbeak

Shannon L Kelleher

David I Soybel

Affiliations

Soon will be listed here.

Abstract

Objective: To determine the prevalence of low-grade inflammation, micronutrient imbalances and associated clinical profiles in patients being evaluated for complex abdominal hernia repair.

Methods: Review of 127 consecutive adult patients for evaluation of complex ventral hernias from January 2012 to March 2013. Records were analyzed to determine the prevalence and correlations of clinical risk factors, attributes of hernias identified by computerized tomography, and laboratory indices of metabolism, inflammation and micronutrient imbalances.

Results: Strong correlations (p < 0.001) were established for body mass index (BMI) with volume of hernia content and C-reactive protein (CRP) level. CRP levels correlated strongly with red cell distribution width and inversely with zinc (p < 0.01). Evidence of micronutrient imbalance (abnormal zinc or red cell distribution width [RDW]) was observed in 48%.

Conclusions: In this comorbidity-rich population with known variability in surgical outcomes, the prevalence of chronic inflammation and micronutrient deficiency are high enough to warrant systemic preoperative evaluation given their possible effect on wound healing and convalescence. Simple repletion is unlikely to improve outcomes without attention to the biological stresses that are associated with micronutrient imbalance.

Citing Articles

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Eisenberg D, Shikora S, Aarts E, Aminian A, Angrisani L, Cohen R Obes Surg. 2022; 33(1):3-14.

PMID: 36336720 PMC: 9834364. DOI: 10.1007/s11695-022-06332-1.

Ventral Abdominal Hernia.

Tchernev G, Chokoeva A, Lotti J, Franca K, Lotti T Open Access Maced J Med Sci. 2017; 5(5):694-695.

PMID: 28932317 PMC: 5591606. DOI: 10.3889/oamjms.2017.154.

Immune and metabolic responses in early and late sepsis during mild dietary zinc restriction.

Crowell K, Phillips B, Kelleher S, Soybel D, Lang C J Surg Res. 2017; 210:47-58.

PMID: 28457340 PMC: 5412598. DOI: 10.1016/j.jss.2016.10.020.

References

Segal R, Baumoehl Y, Elkayam O, Levartovsky D, Litinsky I, Paran D . Anemia, serum vitamin B12, and folic acid in patients with rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus. Rheumatol Int. 2003; 24(1):14-9. DOI: 10.1007/s00296-003-0323-2. View

Fagundes C, Glaser R, Hwang B, Malarkey W, Kiecolt-Glaser J . Depressive symptoms enhance stress-induced inflammatory responses. Brain Behav Immun. 2012; 31:172-6. PMC: 3518610. DOI: 10.1016/j.bbi.2012.05.006. View

Salle A, Demarsy D, Poirier A, Lelievre B, Topart P, Guilloteau G . Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes Surg. 2010; 20(12):1660-70. DOI: 10.1007/s11695-010-0237-5. View

Afridi H, Kazi T, Kazi N, Jamali M, Arain M, Sirajuddin . Evaluation of cadmium, lead, nickel and zinc status in biological samples of smokers and nonsmokers hypertensive patients. J Hum Hypertens. 2009; 24(1):34-43. PMC: 3011091. DOI: 10.1038/jhh.2009.39. View

Hallbook T, Hedelin H . Zinc metabolism and surgical trauma. Br J Surg. 1977; 64(4):271-3. DOI: 10.1002/bjs.1800640412. View

Rawdin B, Mellon S, Dhabhar F, Epel E, Puterman E, Su Y . Dysregulated relationship of inflammation and oxidative stress in major depression. Brain Behav Immun. 2012; 31:143-52. PMC: 3669232. DOI: 10.1016/j.bbi.2012.11.011. View

Tubek S . Role of zinc in regulation of arterial blood pressure and in the etiopathogenesis of arterial hypertension. Biol Trace Elem Res. 2007; 117(1-3):39-51. DOI: 10.1007/BF02698082. View

Finan K, Vick C, Kiefe C, Neumayer L, Hawn M . Predictors of wound infection in ventral hernia repair. Am J Surg. 2005; 190(5):676-81. DOI: 10.1016/j.amjsurg.2005.06.041. View

Breuing K, Butler C, Ferzoco S, Franz M, Hultman C, Kilbridge J . Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010; 148(3):544-58. DOI: 10.1016/j.surg.2010.01.008. View

10.

Toh S, Zarshenas N, Jorgensen J . Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009; 25(11-12):1150-6. DOI: 10.1016/j.nut.2009.03.012. View

11.

Pine J, Fusai K, Young R, Sharma D, Davidson B, Menon K . Serum C-reactive protein concentration and the prognosis of ductal adenocarcinoma of the head of pancreas. Eur J Surg Oncol. 2009; 35(6):605-10. DOI: 10.1016/j.ejso.2008.12.002. View

12.

Shea-Budgell M, Dojka M, Nimmo M, Lee D, Xu Z . Marginal zinc deficiency increased the susceptibility to acute lipopolysaccharide-induced liver injury in rats. Exp Biol Med (Maywood). 2006; 231(5):553-8. DOI: 10.1177/153537020623100509. View

13.

Madsen C, Nafstad P, Eikvar L, Schwarze P, Ronningen K, Haaheim L . Association between tobacco smoke exposure and levels of C-reactive protein in the Oslo II Study. Eur J Epidemiol. 2007; 22(5):311-7. DOI: 10.1007/s10654-007-9121-6. View

14.

Strohle A, Wolters M, Hahn A . Micronutrients at the interface between inflammation and infection--ascorbic acid and calciferol: part 1, general overview with a focus on ascorbic acid. Inflamm Allergy Drug Targets. 2010; 10(1):54-63. DOI: 10.2174/187152811794352105. View

15.

Garcia O, Ronquillo D, Caamano M, Camacho M, Long K, Rosado J . Zinc, vitamin A, and vitamin C status are associated with leptin concentrations and obesity in Mexican women: results from a cross-sectional study. Nutr Metab (Lond). 2012; 9(1):59. PMC: 3406981. DOI: 10.1186/1743-7075-9-59. View

16.

Ruiz-Tovar J, Oller I, Galindo I, Llavero C, Arroyo A, Calero A . Change in levels of C-reactive protein (CRP) and serum cortisol in morbidly obese patients after laparoscopic sleeve gastrectomy. Obes Surg. 2013; 23(6):764-9. DOI: 10.1007/s11695-013-0865-7. View

17.

Henzel J, DeWEESE M, Pories W . Significance of magnesium and zinc metabolism in the surgical patient. II. Zinc. Arch Surg. 1967; 95(6):991-9. DOI: 10.1001/archsurg.1967.01330180139023. View

18.

Strohle A, Wolters M, Hahn A . Micronutrients at the interface between inflammation and infection--ascorbic acid and calciferol. Part 2: calciferol and the significance of nutrient supplements. Inflamm Allergy Drug Targets. 2010; 10(1):64-74. DOI: 10.2174/187152811794352097. View

19.

Ennes Dourado Ferro F, de Sousa Lima V, Mello Soares N, Franciscato Cozzolino S, do Nascimento Marreiro D . Biomarkers of metabolic syndrome and its relationship with the zinc nutritional status in obese women. Nutr Hosp. 2011; 26(3):650-4. DOI: 10.1590/S0212-16112011000300032. View

20.

Hultman C, Tong W, Kittinger B, Cairns B, Overby D, Rich P . Management of recurrent hernia after components separation: 10-year experience with abdominal wall reconstruction at an academic medical center. Ann Plast Surg. 2011; 66(5):504-7. DOI: 10.1097/SAP.0b013e31820b3d06. View