Zinc intervention in prevention of pneumonia in elderly

锌干预预防老年人肺炎

• 批准号: 10216609
• 负责人: SIMIN Nikbin MEYDANI
• 金额: $ 33.98万
• 依托单位: TUFTS UNIVERSITY BOSTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10216609
• 关键词: Adverse event; Age; Aging; Antibiotics; Bacterial Pneumonia; Caring; Cause of Death; Cell physiology; Cells; Cellular Immunity; Cessation of life; Clinical Trials; Controlled Clinical Trials; Cost Savings; Data; Dietary Intervention; Dose; Double-Blind Method; Elderly; Frequencies; Geriatric Nursing; Gluconates; Goals; Grant; Health; Homes for the Aged; Hospitalization; Illness Days; Immune; Immune response; Immunologics; Incidence; Individual; Infection; Intake; Intervention; Light; Measures; Mediating; Micronutrients; Morbidity - disease rate; Natural Immunity; Nursing Homes; Outcome; Participant; Patients; Pilot Projects; Placebos; Play; Pneumonia; Population; Populations at Risk; Predisposing Factor; Prevention; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Reporting; Research Personnel; Risk; Risk Factors; Role; Serum; Serum zinc level result; Subjects Selections; Supplementation; T-Lymphocyte; Testing; Viral; Viral Pneumonia; Zinc; Zinc deficiency; Zinc supplementation; antimicrobial; clinical practice; cost; design; dosage; double-blind placebo controlled trial; economic cost; efficacy testing; fight against; improved; innovation; interest; microbial; monocyte; mortality; neutrophil; older patient; prevent; standard of care

Pneumonia (PNA) is a leading cause of death and a major public health problem in the elderly, particularly for nursing home (NH) residents. Thus, there is an urgent need for effective strategies to prevent PNA in elderly. An important predisposing factor that may account for the higher incidence of PNA in older adults is the age- associated decline in T cell function. Importantly, there are remarkable similarities between Zn deficiency and age-induced changes in T cells. We have shown that 29% of NH residents have low serum Zn levels, which was associated with higher incidence and duration of PNA, and antibiotic use. Although our preliminary data strongly suggest that low serum Zn is an independent risk factor for PNA in the elderly, a controlled clinical trial is critically needed to determine the efficacy of Zn supplementation in PNA prevention in this population. The objective of the larger clinical trial that will pursue the studies proposed in this R34 is to determine the effects of Zn supplementation on PNA outcomes in NH elderly and to understand their mechanistic basis. Our central hypothesis is that improving Zn status in NH elderly with low serum Zn will reduce the incidence and duration of PNA, and the frequency of antibiotic use, and that the effect of Zn is mediated mainly through the improvement of T cell function and/or innate immunity. Our rationale for conducting the proposed clinical trial is to determine the value of Zn supplementation as an inexpensive, easily implemented intervention that would aid in the prevention of PNA in the elderly. In our previous study NH elderly with low serum Zn levels, who were supplemented with 30 mg/d of Zn and ½ RDA of essential micronutrients showed, on average, significantly improved serum Zn levels. However, only 58% of participant became serum Zn adequate. We therefore hypothesize that either a higher dose or a longer duration of supplementation is required to achieve adequate serum Zn levels in all Zn deficient elderly. Our rationale for conducting the proposed pilot study is to determine the most effective yet safe dose for Zn supplementation in NH residents to be used in the larger clinical trial described above. The Specific Aim of the proposed two-year, pilot study is to establish the optimal dose of supplemental Zn to achieve adequate Zn status, and improved T cell function in Zn deficient elderly. We will accomplish this goal by conducting a randomized, placebo-controlled, double-blind clinical trial to test the efficacy of supplementation with 30 or 60 mg/d of Zn for 12 months on serum and immune cell Zn levels, key measures of T cell mediated and innate immunity, and adverse events. The findings of this proposal are scientifically essential, yet sufficient, to allow us to make definitive decisions that inform the final design of our planned clinical trial, which aims to establish the value of Zn supplementation as an inexpensive, easily implemented intervention that would aid in the prevention of PNA, limit the duration of PNA, and consequently reduce the need for antimicrobial therapy in the elderly.

肺炎（PNA）是老年人死亡的主要原因，也是一个主要的公共卫生问题，特别是老年人