Serum Zinc , Copper and Selenium Levels and Psoriasis in US Adults:A cross-sectional analysis of NHANES 2011-2014

Serum Zinc , Copper and Selenium Levels and Psoriasis in US Adults:A cross-sectional analysis of NHANES 2011-2014 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Serum Zinc , Copper and Selenium Levels and Psoriasis in US Adults:A cross-sectional analysis of NHANES 2011-2014 Xiya Zhao, Junqin Li, Xinhua Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3870391/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Several studies have suggested an association between serum copper, zinc, and selenium levels and psoriasis, but the results are disputable. Using data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES), this study examined the association of serum copper, zinc, selenium, and copper/zinc ratios with psoriasis in U.S. adults aged 20 years and older. Multifactorial logistic regression analysis was used to calculate the ratio (OR) and 95% confidence interval (CI) of serum copper, zinc, selenium, and copper/zinc ratios with psoriasis. A total of 3405 adults (1671 men and 1734 women) were enrolled. No significant correlations were found between psoriasis and serum copper, zinc, selenium, and copper/zinc ratios (highest versus lowest quartile) in multifactorial analyses with ORs of 0.65 (0.33, 1.29), 0.73 (0.39, 1.36), 0.82 (0.46, 1.47), and 1.05 (0.55, 2.00), respectively. The findings do not support a significant correlation between serum copper, zinc, and selenium levels and colorectal cancer risk in the general U.S. population. Zinc copper Selenium Psoriasis NHANES Figures Figure 1 Introduction Psoriasis, a widespread chronic systemic immune-mediated skin condition characterized by papulosquamous lesions, impacts individuals globally, irrespective of age.[ 1 ]. Approximately 125 million people worldwide suffer from psoriasis, resulting in a huge burden on individuals and society[ 2 ]. The most common variant is plaque psoriasis, constituting over 80% of cases, and individuals with psoriasis face an elevated risk of comorbidities such as psoriatic arthritis, cardiovascular disease, diabetes mellitus, obesity, inflammatory bowel disease, and nonalcoholic fatty liver disease.[ 3 ]. Effective treatments for the chronic relapsing nature of psoriasis have been the focus of research, including the relationship between certain essential trace elements and the occurrence and development of psoriasis with a view to prevention and treatment. Zinc, copper, and selenium are vital trace elements integral to maintaining the standard structure and physiological activities of cells.Zinc(Zn) is present in more than 300 enzymes that are closely related to metabolism[ 4 ]. In addition, zinc is found in large quantities in nucleic acid binding proteins that control human growth and development[ 5 ]. Zinc is involved in immune regulation and is considered to be a determining factor in the activation of pro- and anti-inflammatory genes[ 6 ]. Copper (Cu) is instrumental in a myriad of biological processes, encompassing cellular respiration, detoxification of free radicals, neuropeptide processing, cell growth, and angiogenesis[ 7 ].Additionally, copper ions rank second in importance for their potential involvement in oxygen-dependent harmful reactions within living organisms. They are integral components of several metalloenzymes, including caeruloplasmin, cytochrome oxidase, superoxide dismutase, ascorbate oxidase, and tyrosinase.[ 8 ].Meanwhile, selenium (Se) stands as a crucial dietary antioxidant trace element. The naturally occurring organic forms of selenium in the body are selenocysteine and selenoproteins[ 9 ]. Selenium plays an important role in biological functions such as antioxidant defense[ 10 ], thyroid hormone formation[ 11 ], DNA synthesis[ 12 ], fertility and reproduction[ 13 ]. To date, there's been limited exploration into the link between zinc, copper, and selenium concerning psoriasis risk, yielding inconsistent findings.Several studies have found significantly lower blood zinc[ 14 – 16 ] and selenium[ 17 , 18 ] levels and significantly higher blood copper[ 19 – 21 ] levels in patients with psoriasis compared to healthy individuals ; however, some of these studies did not find differences in serum zinc levels [ 17 , 21 ]. Most of the aforementioned studies were case-control study designs, the studies included relatively few participants, correlations may not be detected.Notably, the impact of zinc, copper, and selenium on psoriasis risk remains unassessed in the U.S. adult population. To address these gaps, we conducted a comprehensive analysis based on data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES). Our objective was to explore how zinc, copper, and selenium relate to the risk of psoriasis in U.S. adults. Subjects and Methods Study subjects NHANES, an extensively structured survey, follows a demographic, multistage, and stratified approach, crafted to evaluate the health and nutritional well-being of both adults and children in the United States. The survey was overseen by the National Center for Health Statistics (NCHS) and adhered to ethical guidelines approved by the NCHS Ethics Review Board.Specifics include interviews, examinations, and laboratory tests. The baseline information for this study was obtained from the NHANES data from 2011–2014.In this survey round, 19,931 individuals were initially enrolled, and the study eventually included 3405 subjects. Exclusions included persons with missing history of psoriasis, persons with missing serum Cu, Zn, and Se statistics, and those less than or equal to 19 years of age. Figure 1 describes in detail the subject inclusion process of the study.The detailed participant inclusion process for the study is depicted in Fig. 1 . Definition of psoriasis Psoriasis was defined by positive answers to the questions: “Has a doctor or other health professional ever told you that you have psoriasis?” Serum Zinc,Copper and Selenium Levels The processed and frozen serum samples were shipped to the Centers for Disease Control and Prevention in the United States, where serum metal levels of copper, zinc, and selenium were measured using Inductively Coupled Plasma Dynamic Reaction Cell Mass Spectrometry (ICP-DRC-MS), a cutting-edge, multi-elemental analytical technique well versed in trace element analysis. It is worth noting that there were no changes in laboratory equipment, methods or laboratory locations throughout the 2011–2012 and 2013–2014 cycles. Covariates We conducted subgroup analyses employing stratified multivariate logistic regression models, categorizing factors including sex (male/female), age, race (Mexican American/other Hispanic/non-Hispanic white/non-Hispanic black/other race), educational attainment (less than high school/high school/high school or more/other), smoking (yes/no), alcohol consumption (yes/no), body mass index (< 25 kg/m2,normal weight/ 25-29.9kg/m2,overweight/ ≥30 kg/m2obese), and diabetes (yes/no).Furthermore, these stratification factors were considered as potential effect modifiers, and we incorporated an interaction term via likelihood ratio test to assess variations in associations among different subgroups. Absent values for continuous variables were entered as medians, and missing values for categorical variables were entered as patterns of existing cases. Statistical Analysis Sampling weights were applied according to NHANES analytic guidelines and the complexity of a multi-stage cohort survey was taken into account. Logistic regression analysis was performed to analyze the association between serum zinc, copper, and selenium levels and psoriasis. Logistic regression models provided prevalence rates and 95% confidence intervals (OR (95% CI)). Serum zinc, copper and selenium levels were categorized according to quartiles, with quartile 1 as the reference category. Our study included three models: Crude ,without covariate adjustments; 2Model 1: adjusted for sex and age; Model 2: adjusted for all covariates. Significance was measured at p < 0.05. We used R ( http://www.r-project.org ) and EmpowerStats ( http://www.empowerstats.com ) for statistical analysis. Results Baseline characteristics Characteristics of the study participants are shown in Table 1 .Of the 3405 participants, more females than males were represented. The prevalence of psoriasis was 2.9%. Participants with psoriasis tended to be more likely to have co-morbid diabetes and higher rates of smoking compared to participants without psoriasis. Among those with psoriasis, about half of the study population was from the Non-Hispanic White race. There were no significant differences in age, gender, or education level between the two groups. In addition, BMI distribution and drinking status were similar in both groups. There were no significant differences in serum copper, zinc, selenium, and copper/zinc ratios between participants with and without psoriasis. Table 1 Baseline Characteristics of Patients With and Without Psoriasis Variable History of Psoriasis (n = 99 [2.9%]) No History of Psoriasis (n = 3306 [97.1%]) P Value Age (years) 49.19 ± 16.16 48.53 ± 17.62 0.651 Gender (%) 0.747 Men 47.47 49.12 Women 52.53 50.88 Race (%) 0.007 Mexican American 4.04 12.01 Other Hispanic 10.10 9.41 Non-Hispanic White 50.51 40.65 Non-Hispanic Black 13.13 22.41 Other Races 22.22 15.52 Education level(%) 0.789 Less than high school 18.18 22.26 High school or GED 23.23 21.14 Above high school 58.59 56.53 Others 0.00 0.06 Smoking(%) 57.58 42.38 0.003 Alcohol use(%) 78.26 72.87 0.251 BMI (kg/m2 ) 29.02 ± 7.08 28.98 ± 7.10 0.948 Diabetes 20.20 12.22 0.018 Serum copper(µg/dL) 118.09 ± 26.68 119.97 ± 30.71 0.698 Serum zinc(µg/dL) 81.09 ± 16.67 81.82 ± 15.47 0.360 Copper/zinc ratio 1.51 ± 0.45 1.52 ± 0.51 0.930 Serum se(µg/dL) 129.86 ± 16.82 129.94 ± 19.32 0.781 Mean ± SD for continuous variables: the p-value was calculated by weighted linear regression model. % for categorical variables: the p-value was calculated by a weighted chi-square test. BMI, body mass index. Logistic Regression Models Table 2 shows the relationship between serum copper, zinc, selenium and copper/zinc ratio and risk of psoriasis. In the age- and sex-adjusted models, serum copper levels were not significantly associated with psoriasis. Similar results were observed in multivariable corrected models, with ORs (95% CIs) of 0.66 (0.36, 1.19), 0.67 (0.36, 1.24), and 0.65 (0.33, 1.29) for quartiles 2–4, respectively, when compared with the lowest quartile of serum copper levels. For serum zinc, selenium and copper/zinc ratios, no significant correlation was found between the values of the 2nd − 4th quartiles compared to the 1st quartile and psoriasis levels in either model. The ORs of serum zinc, selenium and copper/zinc ratios with psoriasis for the 4th quartile were 0.73 (0.39–1.36), 1.05 (0.55- 2.00) and 0.82 (0.46–1.47). Table 2 Weighted odds ratios (95% confidence intervals) of psoriasis across quartiles of serum levels of copper, zinc,selenium and Copper/zinc ratio,NHANES 2011–2014 Item Level cutoff Cases/participants Crude Model 1 Model 2 Serum copper (µg/dL) Quartile 1 24.7–99.4 30/846 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Quartile 2 99.5–114.5 21/848 0.69 (0.39–1.22) 0.66 (0.37–1.18) 0.66 (0.36–1.19) Quartile 3 114.6–134.5 24/857 0.78 (0.45–1.35) 0.72 (0.41–1.29) 0.67 (0.36–1.24) Quartile4 134.7–295.6 24/854 0.79 (0.46–1.36) 0.71 (0.38–1.30) 0.65 (0.33–1.29) P trend 0.997 0.995 0.994 Serum zinc (µg/dL) Quartile 1 40.9–71.4 26/843 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Quartile 2 71.5–80.3 30/858 1.14 (0.67–1.94) 1.14 (0.67–1.95) 1.13 (0.64–1.98) Quartile 3 80.4–90.1 22/842 0.84 (0.47–1.50) 0.85 (0.48–1.50) 0.81 (0.44–1.49) Quartile 4 90.2–232.5 21/862 0.79 (0.44–1.41) 0.79 (0.44–1.42) 0.73 (0.39–1.36) P trend 0.991 0.991 0.989 Copper/zinc ratio Quartile 1 < 1.19 26/851 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Quartile 2 1.19–1.44 25/851 0.96 (0.55–1.68) 0.937 (0.53–1.65) 0.934 (0.52–1.67) Quartile 3 1.44–1.73 19/851 0.73 (0.40–1.32) 0.691 (0.37–1.29) 0.675 (0.35–1.31) Quartile 4 > 1.73 29/852 1.12 (0.65–1.92) 1.065 (0.59–1.93) 1.05 (0.55-2.00) P trend 1.092 1.055 1.026 Serum selenium (µg/dL) Quartile 1 70.6-117.4 27/847 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) 1.00 (ref.) Quartile 2 117.5–128 19/852 0.693 (0.38–1.26) 0.694 (0.38–1.26) 0.527 (0.28–1.01) Quartile 3 128.1-140.3 26/844 0.965 (0.56–1.67) 0.968 (0.56–1.68) 0.866 (0.49–1.53) Quartile 4 140.4-299.1 27/862 0.983 (0.57–1.69) 0.991 (0.57–1.72) 0.82 (0.46–1.47) P trend 1.002 1.002 0.999 Model 1 was adjusted for sex and age. Model 2 was adjusted for sex, age, race, educational level, body mass index (BMI), smoking status, alcohol status, and diabetes Discussion After cross-sectional analysis of 3405 participants, this large, nationally representative study found no statistically significant associations between serum zinc, copper, and selenium levels, nor the copper/zinc ratio, and psoriasis. The available evidence regarding the relationship between zinc and psoriasis is limited and conflicting. Our results are consistent with some studies showing no independent association between serum zinc and psoriasis[ 17 , 21 ]. However, other investigations indicate that individuals with psoriasis exhibit lower serum zinc ion concentrations than healthy controls[ 14 , 15 , 16 ]. A negative relation also was observed between PASI score and zinc ion concentration in the IMQ-induced psoriasis mouse model[ 22 ]. Taken together, The findings from these studies imply that inadequate levels of zinc ions could be a pivotal factor contributing to the onset of psoriasis. Both zinc deficiency and excess are known to produce redox stress[ 23 ]. In addition, severe zinc deficiency has been associated with a decreased proportions of T helper and cytotoxic T cells, heightened monocyte cytotoxicity, and decreased natural killer cell activity[ 24 ]. SLC35E1 has been found to play a role in psoriasis by promoting proliferation of keratin-forming cells through regulation of zinc ion concentration[ 22 ].In addition, supplementation with zinc ions may alleviate psoriasis symptoms. Currently, topical formulations of zinc pyrithione are proving to be therapeutic in limited psoriasis[ 25 ]. Zinc chloride (ZnCl2), zinc disodium ethylenediaminetetraacetate (Zn-EDTA), and zinc gluconate (Zn-GLU) significantly inhibited mitosis in the vaginal epithelium of mice by affecting antioxidant enzyme activities and interleukin (ILs) levels in psoriatic mice[ 26 ].The hypothesis is that zinc ion supplementation could be a potential treatment for psoriasis. Copper stands out as a crucial trace metal, and multiple studies have underscored elevated blood copper levels in psoriasis patients compared to their healthy counterparts [ 19 – 21 ]. Furthermore, a positive correlation exists between copper levels and the severity scores of psoriasis [ 19 , 24 ]. The surplus of copper is recognized for its ability to trigger reactive oxygen species, culminating in oxidative stress and inflammatory responses [ 27 ]. Consequently, the heightened serum copper levels observed in our study may merely serve as an indicator of inflammation.Earlier research has illuminated that individuals following a high-copper diet exhibit increased cytokine production and peripheral blood lymphocyte counts [ 28 , 29 ]. Notably, copper levels also show a correlation with rheumatoid arthritis (RA) disease activity and serum cytokine levels [ 30 , 31 ]. Serum copper predominantly mirrors serum copper cyanin [ 32 ], with cuprocyanin levels known to surge by 50% or more in various physical stress conditions, including trauma, inflammation, or disease [ 33 ]. The parallel elevation in serum cuprocyanin and copper levels has been substantiated in psoriasis patients by Hinks et al [ 34 ].Remarkably, studies have brought to light that tetrathiomolybdate (TM), a copper chelator, effectively inhibits imiquimod-induced psoriasis-like skin inflammation in mice [ 35 ]. TM induces a reduction in cumulative score, epidermal thickness, and ki-67 expression, alongside lowering cytokine levels in the skin by impeding the activation of keratinocytes and splenocytes. This underscores the potential of a copper chelator, such as TM, as a promising agent for psoriasis treatment. However, it is imperative to conduct further studies to elucidate the precise role of copper in the pathogenesis of psoriasis. Although our results did not show that serum selenium is associated with the risk of psoriasis, according to a part of previous studies, serum selenium concentrations are decreased in patients with psoriasis[ 17 , 18 ]. Several reviews have emphasized the potential of Se as an antioxidant for the treatment of diseases by exerting an immunostimulatory effect enhancing the function of immune and thyroid cells[ 36 , 37 , 38 ]. Selenium deficiency induces higher levels of inflammatory cytokines and immune responses, thereby augmenting vulnerability to infections[ 39 ]. A case-control study involving 60 psoriasis patients and 58 healthy subjects revealed lower serum selenium concentrations in individuals with psoriasis (71.89 ± 16.90 µg/L) compared to controls (79.42 ± 18.97 µg/L), even following NB-UVB treatment[ 40 ]. However, selenium supplementation remains controversial given the small gap between beneficial and harmful intakes of selenium. Elevated serum copper and reduced serum zinc levels are commonly observed in patients with psoriasis, and therefore the Cu/Zn ratio is significantly higher than that of controls.Wacewicz et al. found significant correlation coefficients between CRP and Cu/Zn, and therefore serum Cu/Zn may be useful as an indicator of the extent of acute inflammatory tissue damage and the efficacy of treatment in psoriasis[ 41 ].Gao et al. identified a marked rise in serum zinc levels and a pronounced decline in serum copper in patients with psoriatic arthritis after intravenous methotrexate administration[42].In conclusion, treatment that normalizes serum copper and zinc levels improves the prognosis of patients with psoriasis. This study boasts a significant strength in utilizing a sizable, nationally representative sample of adults in the United States. It is the largest cross-sectional study investigating the association between serum zinc, copper, and selenium and psoriasis to date. We recognize some limitations of this study. The first is reverse causality caused by the cross-sectional design of NHANES. Second, the definition of psoriasis patients was based on a validated questionnaire that was not confirmed by linkage to a dermatologic registry. In addition, other covariates not considered in this analysis may be of concern. Finally, the association between dietary intake of zinc, copper, and selenium and risk of psoriasis was not considered in this analysis. In conclusion, the study found no substantial association between serum zinc, copper and selenium levels and psoriasis in US adults.Furthermore, large longitudinal studies should be needed to confrm these fndings. Declarations Acknowledgements The authors thank the National Center for Health Statistics of the Centers for Disease Control and Prevention for sharing the data. Author Contribution All named authors contributed to the final paper as follows: Xiya Zhao contributed to the concept and design, statistical analysis, and drafting of the manuscript. Dr.Junqin Li contributed to the statistical analysis and drafting of the manuscript. Dr. Xinhua LI contributed to the concept and design and resolution of any discrepancies in study eligibility criteria. Funding This work was supported by the Taiyuan Science and Technology Project Program (No.202213). Data Availability The data of this study will be made available on reasonable request. Code Availability The code of this study will be made available on reasonable request. Ethics Approval NHANES was approved by the National Center for Health Statistics Research Ethics Review Board. Competing Interests The authors declare no competing interests. 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J Trace Elem Med Biol 44:109–114. 10.1016/j.jtemb.2017.06.008 Gao Y, Li X, Liu T, Liu Z (2021) The Effect of Methotrexate on Serum Levels of Trace/Mineral Elements in Patients with Psoriatic Arthritis. Biol Trace Elem Res 199:4498–4503. 10.1007/s12011-021-02594-5 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3870391","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":267629913,"identity":"a3081def-baca-4504-b795-0dd968f250b7","order_by":0,"name":"Xiya Zhao","email":"","orcid":"","institution":"Taiyuan Central Hospital, Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiya","middleName":"","lastName":"Zhao","suffix":""},{"id":267629914,"identity":"b51dc476-643d-40db-b22d-c38eb4b160af","order_by":1,"name":"Junqin Li","email":"","orcid":"","institution":"Taiyuan Central Hospital, Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Junqin","middleName":"","lastName":"Li","suffix":""},{"id":267629915,"identity":"3e69ad78-79bd-42c1-8a16-4063c04de222","order_by":2,"name":"Xinhua Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYFAC5oYDDAYMCUDGARBJGPAwMMK0sCUQrwVEAxXzGBDnLHuJxMbDPAV38gyOn/n84eEOOwb+9m78lvFIJDYcnGHwrNjgTO42icQzyQwSZ85uIKjlwAeDw4kbDuRuY0hsY2YwkMglQksCSMv5N48/JLbVE6kFbMuNHAaJxLbDRGg58xDkl8OJM288MwNqOc5D0C/s7cmHP/P8OZzYdz758cefbdVy/O29+LUwCCSgWYtfOQjwHyCsZhSMglEwCkY4AAA+NFFmMWellAAAAABJRU5ErkJggg==","orcid":"","institution":"Taiyuan Central Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xinhua","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-01-16 16:20:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3870391/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3870391/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49814478,"identity":"3462a01a-df27-4a6b-b287-5109c6a71ade","added_by":"auto","created_at":"2024-01-18 13:04:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":285021,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of participants selection. NHANES, National Health and Nutrition Examination Survey.\u003c/p\u003e","description":"","filename":"OnlineFIGURE1ZINC1.png","url":"https://assets-eu.researchsquare.com/files/rs-3870391/v1/d441c56e07c0a3d5026090bb.png"},{"id":51340924,"identity":"da584048-55b5-4c73-bc50-11430a0f0a14","added_by":"auto","created_at":"2024-02-19 23:22:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":362624,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3870391/v1/9b5b2cf6-4bc3-46a4-a2c5-f4bf1fe207e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Serum Zinc , Copper and Selenium Levels and Psoriasis in US Adults:A cross-sectional analysis of NHANES 2011-2014","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePsoriasis, a widespread chronic systemic immune-mediated skin condition characterized by papulosquamous lesions, impacts individuals globally, irrespective of age.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Approximately 125\u0026nbsp;million people worldwide suffer from psoriasis, resulting in a huge burden on individuals and society[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The most common variant is plaque psoriasis, constituting over 80% of cases, and individuals with psoriasis face an elevated risk of comorbidities such as psoriatic arthritis, cardiovascular disease, diabetes mellitus, obesity, inflammatory bowel disease, and nonalcoholic fatty liver disease.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Effective treatments for the chronic relapsing nature of psoriasis have been the focus of research, including the relationship between certain essential trace elements and the occurrence and development of psoriasis with a view to prevention and treatment.\u003c/p\u003e \u003cp\u003eZinc, copper, and selenium are vital trace elements integral to maintaining the standard structure and physiological activities of cells.Zinc(Zn) is present in more than 300 enzymes that are closely related to metabolism[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In addition, zinc is found in large quantities in nucleic acid binding proteins that control human growth and development[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Zinc is involved in immune regulation and is considered to be a determining factor in the activation of pro- and anti-inflammatory genes[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Copper (Cu) is instrumental in a myriad of biological processes, encompassing cellular respiration, detoxification of free radicals, neuropeptide processing, cell growth, and angiogenesis[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].Additionally, copper ions rank second in importance for their potential involvement in oxygen-dependent harmful reactions within living organisms. They are integral components of several metalloenzymes, including caeruloplasmin, cytochrome oxidase, superoxide dismutase, ascorbate oxidase, and tyrosinase.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].Meanwhile, selenium (Se) stands as a crucial dietary antioxidant trace element. The naturally occurring organic forms of selenium in the body are selenocysteine and selenoproteins[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Selenium plays an important role in biological functions such as antioxidant defense[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], thyroid hormone formation[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], DNA synthesis[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], fertility and reproduction[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo date, there's been limited exploration into the link between zinc, copper, and selenium concerning psoriasis risk, yielding inconsistent findings.Several studies have found significantly lower blood zinc[\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and selenium[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] levels and significantly higher blood copper[\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] levels in patients with psoriasis compared to healthy individuals ; however, some of these studies did not find differences in serum zinc levels [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Most of the aforementioned studies were case-control study designs, the studies included relatively few participants, correlations may not be detected.Notably, the impact of zinc, copper, and selenium on psoriasis risk remains unassessed in the U.S. adult population.\u003c/p\u003e \u003cp\u003eTo address these gaps, we conducted a comprehensive analysis based on data from the 2011\u0026ndash;2014 National Health and Nutrition Examination Survey (NHANES). Our objective was to explore how zinc, copper, and selenium relate to the risk of psoriasis in U.S. adults.\u003c/p\u003e"},{"header":"Subjects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy subjects\u003c/h2\u003e \u003cp\u003eNHANES, an extensively structured survey, follows a demographic, multistage, and stratified approach, crafted to evaluate the health and nutritional well-being of both adults and children in the United States. The survey was overseen by the National Center for Health Statistics (NCHS) and adhered to ethical guidelines approved by the NCHS Ethics Review Board.Specifics include interviews, examinations, and laboratory tests. The baseline information for this study was obtained from the NHANES data from 2011\u0026ndash;2014.In this survey round, 19,931 individuals were initially enrolled, and the study eventually included 3405 subjects. Exclusions included persons with missing history of psoriasis, persons with missing serum Cu, Zn, and Se statistics, and those less than or equal to 19 years of age. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e describes in detail the subject inclusion process of the study.The detailed participant inclusion process for the study is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDefinition of psoriasis\u003c/h2\u003e \u003cp\u003ePsoriasis was defined by positive answers to the questions: \u0026ldquo;Has a doctor or other health professional ever told you that you have psoriasis?\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSerum Zinc,Copper and Selenium Levels\u003c/h2\u003e \u003cp\u003eThe processed and frozen serum samples were shipped to the Centers for Disease Control and Prevention in the United States, where serum metal levels of copper, zinc, and selenium were measured using Inductively Coupled Plasma Dynamic Reaction Cell Mass Spectrometry (ICP-DRC-MS), a cutting-edge, multi-elemental analytical technique well versed in trace element analysis. It is worth noting that there were no changes in laboratory equipment, methods or laboratory locations throughout the 2011\u0026ndash;2012 and 2013\u0026ndash;2014 cycles.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCovariates\u003c/h2\u003e \u003cp\u003eWe conducted subgroup analyses employing stratified multivariate logistic regression models, categorizing factors including sex (male/female), age, race (Mexican American/other Hispanic/non-Hispanic white/non-Hispanic black/other race), educational attainment (less than high school/high school/high school or more/other), smoking (yes/no), alcohol consumption (yes/no), body mass index (\u0026lt;\u0026thinsp;25 kg/m2,normal weight/ 25-29.9kg/m2,overweight/ \u0026ge;30 kg/m2obese), and diabetes (yes/no).Furthermore, these stratification factors were considered as potential effect modifiers, and we incorporated an interaction term via likelihood ratio test to assess variations in associations among different subgroups. Absent values for continuous variables were entered as medians, and missing values for categorical variables were entered as patterns of existing cases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003e Sampling weights were applied according to NHANES analytic guidelines and the complexity of a multi-stage cohort survey was taken into account. Logistic regression analysis was performed to analyze the association between serum zinc, copper, and selenium levels and psoriasis. Logistic regression models provided prevalence rates and 95% confidence intervals (OR (95% CI)). Serum zinc, copper and selenium levels were categorized according to quartiles, with quartile 1 as the reference category. Our study included three models: Crude ,without covariate adjustments; 2Model 1: adjusted for sex and age; Model 2: adjusted for all covariates. Significance was measured at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. We used R (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.r-project.org\u003c/span\u003e\u003cspan address=\"http://www.r-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) and EmpowerStats (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.empowerstats.com\u003c/span\u003e\u003cspan address=\"http://www.empowerstats.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) for statistical analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003eCharacteristics of the study participants are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.Of the 3405 participants, more females than males were represented. The prevalence of psoriasis was 2.9%. Participants with psoriasis tended to be more likely to have co-morbid diabetes and higher rates of smoking compared to participants without psoriasis. Among those with psoriasis, about half of the study population was from the Non-Hispanic White race. There were no significant differences in age, gender, or education level between the two groups. In addition, BMI distribution and drinking status were similar in both groups. There were no significant differences in serum copper, zinc, selenium, and copper/zinc ratios between participants with and without psoriasis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of Patients With and Without Psoriasis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHistory of Psoriasis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;99 [2.9%])\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo History of Psoriasis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;3306 [97.1%])\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.19\u0026thinsp;\u0026plusmn;\u0026thinsp;16.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.53\u0026thinsp;\u0026plusmn;\u0026thinsp;17.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.651\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.747\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMexican American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Races\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school or GED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol use(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m2 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.02\u0026thinsp;\u0026plusmn;\u0026thinsp;7.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.98\u0026thinsp;\u0026plusmn;\u0026thinsp;7.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum copper(\u0026micro;g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118.09\u0026thinsp;\u0026plusmn;\u0026thinsp;26.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119.97\u0026thinsp;\u0026plusmn;\u0026thinsp;30.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum zinc(\u0026micro;g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.09\u0026thinsp;\u0026plusmn;\u0026thinsp;16.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.82\u0026thinsp;\u0026plusmn;\u0026thinsp;15.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCopper/zinc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum se(\u0026micro;g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129.86\u0026thinsp;\u0026plusmn;\u0026thinsp;16.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129.94\u0026thinsp;\u0026plusmn;\u0026thinsp;19.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD for continuous variables: the p-value was calculated by weighted linear regression model. % for categorical variables: the p-value was calculated by a weighted chi-square test. BMI, body mass index.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eLogistic Regression Models\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the relationship between serum copper, zinc, selenium and copper/zinc ratio and risk of psoriasis. In the age- and sex-adjusted models, serum copper levels were not significantly associated with psoriasis. Similar results were observed in multivariable corrected models, with ORs (95% CIs) of 0.66 (0.36, 1.19), 0.67 (0.36, 1.24), and 0.65 (0.33, 1.29) for quartiles 2\u0026ndash;4, respectively, when compared with the lowest quartile of serum copper levels. For serum zinc, selenium and copper/zinc ratios, no significant correlation was found between the values of the 2nd \u0026minus;\u0026thinsp;4th quartiles compared to the 1st quartile and psoriasis levels in either model. The ORs of serum zinc, selenium and copper/zinc ratios with psoriasis for the 4th quartile were 0.73 (0.39\u0026ndash;1.36), 1.05 (0.55- 2.00) and 0.82 (0.46\u0026ndash;1.47).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWeighted odds ratios (95% confidence intervals) of psoriasis across quartiles of serum levels of copper, zinc,selenium and Copper/zinc ratio,NHANES 2011\u0026ndash;2014\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLevel cutoff\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases/participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCrude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum copper (\u0026micro;g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.7\u0026ndash;99.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30/846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99.5\u0026ndash;114.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21/848\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.69 (0.39\u0026ndash;1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66 (0.37\u0026ndash;1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.66 (0.36\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e114.6\u0026ndash;134.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24/857\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78 (0.45\u0026ndash;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72 (0.41\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.67 (0.36\u0026ndash;1.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e134.7\u0026ndash;295.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24/854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79 (0.46\u0026ndash;1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71 (0.38\u0026ndash;1.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.65 (0.33\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum zinc (\u0026micro;g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40.9\u0026ndash;71.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26/843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71.5\u0026ndash;80.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30/858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14 (0.67\u0026ndash;1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.14 (0.67\u0026ndash;1.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.13 (0.64\u0026ndash;1.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80.4\u0026ndash;90.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22/842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84 (0.47\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85 (0.48\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81 (0.44\u0026ndash;1.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90.2\u0026ndash;232.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21/862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79 (0.44\u0026ndash;1.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79 (0.44\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.73 (0.39\u0026ndash;1.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCopper/zinc ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26/851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.19\u0026ndash;1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25/851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96 (0.55\u0026ndash;1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.937 (0.53\u0026ndash;1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.934 (0.52\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.44\u0026ndash;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73 (0.40\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.691 (0.37\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.675 (0.35\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29/852\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.12 (0.65\u0026ndash;1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.065 (0.59\u0026ndash;1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.05 (0.55-2.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum selenium (\u0026micro;g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70.6-117.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27/847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00 (ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117.5\u0026ndash;128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/852\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.693 (0.38\u0026ndash;1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.694 (0.38\u0026ndash;1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.527 (0.28\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e128.1-140.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26/844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.965 (0.56\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.968 (0.56\u0026ndash;1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.866 (0.49\u0026ndash;1.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuartile 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140.4-299.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27/862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.983 (0.57\u0026ndash;1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.991 (0.57\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.82 (0.46\u0026ndash;1.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eModel 1 was adjusted for sex and age.\u003c/p\u003e \u003cp\u003eModel 2 was adjusted for sex, age, race, educational level, body mass index (BMI), smoking status, alcohol status, and diabetes\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAfter cross-sectional analysis of 3405 participants, this large, nationally representative study found no statistically significant associations between serum zinc, copper, and selenium levels, nor the copper/zinc ratio, and psoriasis.\u003c/p\u003e \u003cp\u003eThe available evidence regarding the relationship between zinc and psoriasis is limited and conflicting. Our results are consistent with some studies showing no independent association between serum zinc and psoriasis[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, other investigations indicate that individuals with psoriasis exhibit lower serum zinc ion concentrations than healthy controls[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A negative relation also was observed between PASI score and zinc ion concentration in the IMQ-induced psoriasis mouse model[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Taken together, The findings from these studies imply that inadequate levels of zinc ions could be a pivotal factor contributing to the onset of psoriasis. Both zinc deficiency and excess are known to produce redox stress[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In addition, severe zinc deficiency has been associated with a decreased proportions of T helper and cytotoxic T cells, heightened monocyte cytotoxicity, and decreased natural killer cell activity[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. SLC35E1 has been found to play a role in psoriasis by promoting proliferation of keratin-forming cells through regulation of zinc ion concentration[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].In addition, supplementation with zinc ions may alleviate psoriasis symptoms. Currently, topical formulations of zinc pyrithione are proving to be therapeutic in limited psoriasis[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Zinc chloride (ZnCl2), zinc disodium ethylenediaminetetraacetate (Zn-EDTA), and zinc gluconate (Zn-GLU) significantly inhibited mitosis in the vaginal epithelium of mice by affecting antioxidant enzyme activities and interleukin (ILs) levels in psoriatic mice[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].The hypothesis is that zinc ion supplementation could be a potential treatment for psoriasis.\u003c/p\u003e \u003cp\u003eCopper stands out as a crucial trace metal, and multiple studies have underscored elevated blood copper levels in psoriasis patients compared to their healthy counterparts [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Furthermore, a positive correlation exists between copper levels and the severity scores of psoriasis [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The surplus of copper is recognized for its ability to trigger reactive oxygen species, culminating in oxidative stress and inflammatory responses [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Consequently, the heightened serum copper levels observed in our study may merely serve as an indicator of inflammation.Earlier research has illuminated that individuals following a high-copper diet exhibit increased cytokine production and peripheral blood lymphocyte counts [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Notably, copper levels also show a correlation with rheumatoid arthritis (RA) disease activity and serum cytokine levels [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Serum copper predominantly mirrors serum copper cyanin [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], with cuprocyanin levels known to surge by 50% or more in various physical stress conditions, including trauma, inflammation, or disease [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The parallel elevation in serum cuprocyanin and copper levels has been substantiated in psoriasis patients by Hinks et al [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].Remarkably, studies have brought to light that tetrathiomolybdate (TM), a copper chelator, effectively inhibits imiquimod-induced psoriasis-like skin inflammation in mice [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. TM induces a reduction in cumulative score, epidermal thickness, and ki-67 expression, alongside lowering cytokine levels in the skin by impeding the activation of keratinocytes and splenocytes. This underscores the potential of a copper chelator, such as TM, as a promising agent for psoriasis treatment. However, it is imperative to conduct further studies to elucidate the precise role of copper in the pathogenesis of psoriasis.\u003c/p\u003e \u003cp\u003eAlthough our results did not show that serum selenium is associated with the risk of psoriasis, according to a part of previous studies, serum selenium concentrations are decreased in patients with psoriasis[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Several reviews have emphasized the potential of Se as an antioxidant for the treatment of diseases by exerting an immunostimulatory effect enhancing the function of immune and thyroid cells[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Selenium deficiency induces higher levels of inflammatory cytokines and immune responses, thereby augmenting vulnerability to infections[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A case-control study involving 60 psoriasis patients and 58 healthy subjects revealed lower serum selenium concentrations in individuals with psoriasis (71.89\u0026thinsp;\u0026plusmn;\u0026thinsp;16.90 \u0026micro;g/L) compared to controls (79.42\u0026thinsp;\u0026plusmn;\u0026thinsp;18.97 \u0026micro;g/L), even following NB-UVB treatment[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, selenium supplementation remains controversial given the small gap between beneficial and harmful intakes of selenium.\u003c/p\u003e \u003cp\u003eElevated serum copper and reduced serum zinc levels are commonly observed in patients with psoriasis, and therefore the Cu/Zn ratio is significantly higher than that of controls.Wacewicz et al. found significant correlation coefficients between CRP and Cu/Zn, and therefore serum Cu/Zn may be useful as an indicator of the extent of acute inflammatory tissue damage and the efficacy of treatment in psoriasis[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].Gao et al. identified a marked rise in serum zinc levels and a pronounced decline in serum copper in patients with psoriatic arthritis after intravenous methotrexate administration[42].In conclusion, treatment that normalizes serum copper and zinc levels improves the prognosis of patients with psoriasis.\u003c/p\u003e \u003cp\u003eThis study boasts a significant strength in utilizing a sizable, nationally representative sample of adults in the United States. It is the largest cross-sectional study investigating the association between serum zinc, copper, and selenium and psoriasis to date. We recognize some limitations of this study. The first is reverse causality caused by the cross-sectional design of NHANES. Second, the definition of psoriasis patients was based on a validated questionnaire that was not confirmed by linkage to a dermatologic registry. In addition, other covariates not considered in this analysis may be of concern. Finally, the association between dietary intake of zinc, copper, and selenium and risk of psoriasis was not considered in this analysis.\u003c/p\u003e \u003cp\u003eIn conclusion, the study found no substantial association between serum zinc, copper and selenium levels and psoriasis in US adults.Furthermore, large longitudinal studies should be needed to confrm these fndings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e The authors thank the National Center for Health Statistics of the Centers for Disease Control and Prevention for sharing the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution \u003c/strong\u003eAll named authors contributed to the final paper as follows: Xiya Zhao contributed to the concept and design, statistical analysis, and drafting of the manuscript. Dr.Junqin Li contributed to the statistical analysis and drafting of the manuscript. Dr. Xinhua LI contributed to the concept and design and resolution of any discrepancies in study eligibility criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003eThis work was supported by the Taiyuan Science and Technology Project Program (No.202213).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e The data of this study will be made available on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode Availability\u003c/strong\u003e The code of this study will be made available on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e NHANES was approved by the National Center for Health Statistics Research Ethics Review Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGriffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN (2021) Psoriasis Lancet 397:1301\u0026ndash;1315. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(20)32549-6\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(20)32549-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArmstrong AW, Read C (2020) Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. 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Biol Trace Elem Res 199:4498\u0026ndash;4503. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12011-021-02594-5\u003c/span\u003e\u003cspan address=\"10.1007/s12011-021-02594-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Zinc, copper, Selenium, Psoriasis, NHANES","lastPublishedDoi":"10.21203/rs.3.rs-3870391/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3870391/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSeveral studies have suggested an association between serum copper, zinc, and selenium levels and psoriasis, but the results are disputable. Using data from the 2011\u0026ndash;2014 National Health and Nutrition Examination Survey (NHANES), this study examined the association of serum copper, zinc, selenium, and copper/zinc ratios with psoriasis in U.S. adults aged 20 years and older. Multifactorial logistic regression analysis was used to calculate the ratio (OR) and 95% confidence interval (CI) of serum copper, zinc, selenium, and copper/zinc ratios with psoriasis. A total of 3405 adults (1671 men and 1734 women) were enrolled. No significant correlations were found between psoriasis and serum copper, zinc, selenium, and copper/zinc ratios (highest versus lowest quartile) in multifactorial analyses with ORs of 0.65 (0.33, 1.29), 0.73 (0.39, 1.36), 0.82 (0.46, 1.47), and 1.05 (0.55, 2.00), respectively. The findings do not support a significant correlation between serum copper, zinc, and selenium levels and colorectal cancer risk in the general U.S. population.\u003c/p\u003e","manuscriptTitle":"Serum Zinc , Copper and Selenium Levels and Psoriasis in US Adults:A cross-sectional analysis of NHANES 2011-2014","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-18 13:04:50","doi":"10.21203/rs.3.rs-3870391/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"83a1af76-d6d8-4317-907e-d2cf0d097fe6","owner":[],"postedDate":"January 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-19T23:14:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-18 13:04:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3870391","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3870391","identity":"rs-3870391","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}