Zinc, Copper and Magnesium Intake in a Daily Diet in Opiate‑Addicted Persons Before and After 5 Years of Methadone Treatment
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KolarzykProbl Hig E Epidemiol i wsp. Zinc, 2010, copper 91(2): and 243-247 magnesium intake in a daily diet in opiate-addicted persons before and after ... 243 Zinc, copper and magnesium intake in a daily diet in opiate‑addicted persons before and after 5 years of methadone treatment Podaż cynku, miedzi i magnezu w diecie osób uzależnionych od opiatów przed rozpoczęciem oraz po 5 latach trwania leczenia substytucyjnego metadonem Emilia Kolarzyk 1/, Agnieszka Szpanowska-Wohn 1/, Jan Chrostek-Maj 2/ 1/ Department of Hygiene and Ecology, Jagiellonian University, Medical College, Krakow 2/ Rydygier Hospital, Center for Dependency Treatment, Krakow Cel pracy. Oszacowanie podaży cynku, miedzi i magnezu w diecie osób Aim. Estimation of zinc, copper and magnesium intake in the diet of opiate- uzależnionych od opiatów przed rozpoczęciem oraz po 5 latach trwania addicted persons before and after 5 years of methadone maintenance leczenia substytucyjnego metadonem. treatment. Materiał i metoda. Badaniami objęto 35 uzależnionych osób (12 kobiet Material & method. Thirty five opiate-addicted persons were included in i 35 mężczyzn). Sposób żywienia, z uwzględnieniem podaży cynku, miedzi the examination (12 women and 23 men). The nutritional model including i magnezu, był oceniany metodą 24-godzinnego wywiadu. Uzyskane zinc, copper and magnesium intake estimation was analysed on the basis wyniki były odnoszone do norm żywieniowych na bezpiecznym poziomie of a 24-hour nutritional recall. The received values were compared with spożycia. the daily norms of the safe intake level. Wyniki. W badaniu wyjściowym średnia podaż wszystkich ocenianych Results. In the initial examination the mean intake of all analyzed mikroelementów była niższa niż rekomendowana, zarówno w grupie microelements in a daily diet was lower than the recommended both in mężczyzn (59,0-71,5%) jak i w grupie kobiet (43,0-782%). Po 5 latach men (59.0-71.5%) and in women (43.0-78.2%) groups. After 5 years of leczenia substytucyjnego metadonem magnez i cynk był spożywany methadone maintenance treatment in the group of examined women, w zalecanych ilościach przez kobiety, natomiast w grupie mężczyzn spożycie magnesium and zinc were consumed according to the recommended magnezu, cynku i miedzi nie uległo istotnej zmianie i wciąż było niższe values. In the men’s group the magnesium, zinc and copper consumption niż zalecany poziom. did not change and was still lower than the safe consumption level. Wnioski. Badania wykazały nieprawidłowe zachowania żywieniowe osób Conclusions. The quoted results of our examination showed incorrect uzależnionych i były podstawą do podjęcia wysiłków w celu zmotywowania nutritional behaviors and were the reason to motivate addicted patients to badanych do przestrzegania zaleceń żywieniowych, obejmujących respect recommendations concerning the microelements consumption. The również podaż mikroelementów. Powyższe badania były tylko jednym research was one of the elements of multidimensional care over addicted z elementów wielokierunkowej opieki mającej na celu pomóc osobom persons, aimed to help addicted people in recovering and improving their uzależnionym w powrocie do zdrowia, w aspekcie zarówno fizycznym jak physical and mental health. i psychicznym. Key words: magnesium, zinc, copper, 24-hour nutritional recall, opiate Słowa kluczowe: cynk, miedź, magnez, 24-godzinny wywiad żywieniowy, dependence, methadone program. uzależnienie od opiatów, program metadonowy © Probl Hig Epidemiol 2010, 91(2): 243‑247 Adres do korespondencji / Address for correspondence Prof. dr hab. Emilia Kolarzyk www.phie.pl Department of Hygiene and Ecology, Jagiellonian University, Medical Nadesłano: 10.03.2009 College, Krakow, 7 Kopernik Street, Krakow, Poland Zakwalifikowano do druku: 17.05.2010 tel./fax +48-12-422-37-20, e-mail: [email protected] Introduction drug-addicts are the persons from the risk groups of AIDS and sexually transmitted diseases. The The opiate addiction is a severe, chronic disease treatment of addicted persons is very difficult because of central nervous system and addicted persons the drug addiction is connected with neurobiological are the group of patients who may develop, more mechanisms and depends on some psychological, frequently than others, such diseases as: dermatitis, social and economic factors [1,2]. phlebitis (followed by clots in venal system), hepatitis, pancreatitis, osteitis, and in some cases sepsis. The Presently, an important way of help for opiate- (morphine-, heroin-) addicted persons are 244 Probl Hig Epidemiol 2010, 91(2): 243-247 substitutional programs. The most helpful drug The nutritional model of addicted persons was used in long-term treatment of opiate-addiction is assessed by the specialists from the Department of methadone [3,4]. Hygiene and Ecology, Medical College of Jagiellonian Methadone is a synthetic agonist of opioid University, Krakow, on the basis of a 24-hour receptors. It may be administered orally and it is active nutritional recall. The nutritional recall was performed in organisms for 24 hours. Since January 2000 the twice: just before the treatment was started (the initial methadone therapy for opiate-addicted persons has examination – Exam 1) and after 5 years of methadone started in Krakow. Interprofessional collaboration maintenance treatment (the final examination between different specialists is realized – the patients – Exam 2). The nutritional recall was performed during are given the complex psychological, psychiatric and 3 non-consecutive days for every person both in the medical care [5]. A lot of attention is being paid to initial and in the final examination. The “Album of their consumption pattern, their nutritional status products and meal portions” was used in the recall. and dietetic recommendations. It is very important for The obtained quantitative nutritional analyses were addicted persons because a well-balanced diet in the processed with the use of specialized nutrition software aspect of main nutritional products (carbohydrates, calculating nutritional values of a daily diet. proteins and fats) and a proper intake of vitamins and In the present study the analysis concerned the microelements may effectively support the medical main nutritional components (proteins, fats and treatment [6,7]. carbohydrates) and such microelements as: zinc, The research data show that such microelements copper and magnesium. The received data were set as zinc, copper and magnesium play a role in the against the consumption standards for the Polish normalization of physiological and biochemical population on the safe intake level (N) [13]. The functions that had changed because of used drugs normal range was established at ±10% of the safe level [2]. Currently some investigators have been reporting (N±10%). a change in serum trace element contents in drug- The statistical significance of differences between addicted individuals and the different levels of the results obtained in particular examinations were these elements in the blood of addicted persons in calculated by the Mann-Whitney U test. comparison with healthy people were shown [8,9,10]. All subjects gave informed consent prior to their Nevertheless the estimation of the intake of zinc, recruitment in the study. The Ethics Committee for copper and magnesium in the diet of addicted persons Human Research of Jagiellonian University, Medical treated for a long time with methadone has not yet College approved the study. been performed. Results Aim The length of the period of opiate addiction, Estimation of the intake of zinc, copper and age, gender, body mass, body height and BMI values magnesium in the diet of opiate-addicted persons for all examined men and women were presented in before and after 5 years of methadone maintenance particular examinations in Tab. I. treatment. Table I. General and anthropometric characteristics of drug-addicted women and men in the initial (1) and final (2) examinations Materials and Methods Women (N=12) Men (N=23) The studied group included 35 persons (12 Variable X SD Min Max X SD Min Max women and 23 men) treated with methadone Duration of opiate- 8.8 3.5 5.0 15.0 12.0 5.8 6.0 28.0 continuously for at least 5 years. All of them used the addiction [exam.1] so-called „kompot” (literally this Polish word could (years) be translated as English “compote”– stewed fruits), Age at the initial 27.4* 5.8 21.0 37.0 30.4* 5.1 25.0 45.0 “Polish heroin” (heroin, morphine, codeine in small exam [years] amounts, and some amount of 6-monoacetylmo, Age at the final 33.2 5.9 25.0 40.0 36.3 6.2 30.0 49.0 morphine) [11] parenterally, and some of them also exam [years] used amphetamine, THS, LSD or benzodiazepines Height [cm] 168.7 6.1 160.0 177.0 177.8 6.2 163.0 190.0 orally. An individual oral methadone dose adequate Body weight 1[kg] 57.7 4.9 54.0 66.0 73.7* 16.9 51.0 136.0 for blocking the drug craving and hunger was Body weight 2 [kg] 56.0 9.1 50.0 76.0 82.5 25.0 60.0 145.0 established for each patient. An adequate effective BMI 1 [ kg/m2 ] 20.3 1.5 17.6 22.6 23.3* 5.3 17.1 44.9 dose of methadone was administrated daily and serum BMI 2 [ kg/m2 ] 19.8 2.7 17.2 25.4 25.9 7.9 19.0 55.1 methadone concentration was monitored. Urine X – arithmetic mean SD – standard deviation samples were taken regularly to control the patients’ * p – 1:2 < 0.05 abstinence from opiates [12]. Kolarzyk E i wsp. Zinc, copper and magnesium intake in a daily diet in opiate-addicted persons before and after ... 245 Statistically significant elevation in body In the initial examination it was found that weight and BMI values of males were noted in average intake of all 3 analyzed minerals in DNR the final examination in comparison to the initial was lower than the recommended intake on the safe examination. level: 59.0% – Cu, 69.1% – Zn, 71.5% – Mg in men Figure 1 shows the basic nutritional components group and 43.0 – Cu, 76.2% – Zn, 74.2% – Mg in the intake in the diet of examined persons expressed as the women’s group (Fig.