Abstract: FR-PO0217
Link Between Copper-to-Zinc Ratio and Anemia Risk in Older Adults with Reduced Kidney Function: Insights from the NHANES Study
Session Information
- Anemia and Iron Metabolism
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Gembillo, Guido, Universita degli Studi di Messina, Messina, Sicily, Italy
- Soraci, Luca, Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
- Corsonello, Andrea, Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
- Santoro, Domenico, Universita degli Studi di Messina, Messina, Sicily, Italy
Background
The balance between copper and zinc is critical for several physiological processes, including hematopoiesis. Both Zn and Cu are vital for the synthesis and activity of several enzymatic pathways, and maintaining an optimal ratio of these micronutrients is essential for overall body homeostasis. Our study explores the relationship between the copper-to-zinc ratio (Cu/Zn) and the risk of anemia, utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2011–2012.
Methods
A secondary analysis was conducted on data from patients enrolled in the NHANES study, focusing on available information related to kidney function, serum Cu and Zn levels, hemoglobin (hb) and medical history of chronic diseases. A total of 5,972 individuals, with a mean age of 60 years (SD:7), were included in the analysis. Anemia was defined according to the WHO criteria, and estimated glomerular filtration rate (eGFR) was calculated using the updated CKD-EPI equation (2021). The association between tertiles of the Cu/Zn ratio and hb levels was assessed cross-sectionally through linear regression analysis, while the relationship with the presence of anemia was evaluated using logistic regression. All multivariate models were adjusted for potential confounders.
Results
Continuous Cu/Zn ratio was inversely associated with hb levels across the entire study population, with a more pronounced effect observed in individuals with an estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m2. Higher Cu/Zn tertiles were linked to an increased risk of anemia. Specifically, when compared to the first tertile (Cu/Zn = 0.353–1.22), the second tertile showed a significant independent association with anemia (odds ratio [OR], 95% confidence interval [CI]: 1.03, 1.01–1.07). This association was even stronger in the third tertile, compared to the first (OR, 95% CI: 1.10, 1.07–1.18).
Conclusion
Our analysis showed that a higher Cu/Zn ratio was significantly associated with an increased risk of anemia, indicating a potentially detrimental role of Cu compared to Zn in regulating hemoglobin levels. These findings underscore the critical importance of maintaining trace metal homeostasis for optimal hematologic health and point to the need for further investigation of the underlying mechanisms and potential clinical implications.