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‘Cutoff point for selenium deficiency’

European Journal of Clinical Nutrition volume 66, page 1277 (2012)Cite this article

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It is always with great interest that I read your journal. I found your article by Bunupuradah et al.,1 ‘Correlation of selenium and zinc levels to antiretroviral treatment outcomes in Thai HIV-infected children without severe HIV symptom’, both relevant and interesting. However, I was surprised to find that their cutoff point for selenium deficiency was mistaken and misleading. Mistaken because the usual cutoff for deficiency is from 70 to 85 μg/l or between 0.9 and 1 μmol/l.2, 3 Their mistake in setting their very low cutoff point for selenium (Se deficiency <0.1 μmol/l) is due to their use of an article by Krittaphol et al.4 as a reference for this value (reference 17 in the original paper). Krittaphol’s article uses this very low cutoff point as an example in the abstract. This cutoff point for selenium deficiency is almost 9 to 10 times lower than the cutoff points used for selenium deficiency in the literature.2, 5

This unrealistically low cutoff point was misleading, because based on it, the authors concluded that none of the children in the study had selenium deficiency, when in reality, those children were borderline deficient, and some of them, looking at the statistics in the paper, were selenium deficient at baseline. The paper would have been enriched by showing how many of these deficiencies were resolved for both the selenium-deficient and zinc-deficient children after 48 weeks on HAART compared with the control group. The conclusion of the study should have been that:

  • HAART treatment by itself was unable to correct deficiencies, as the increases in selenium from baseline were statistic but not clinically significant, and there were no differences between the two arms of the study. In addition, plasma zinc values were still within the range of deficiency after 48 weeks.

  • Based on the finding above, supplementation with these two micronutrients at nutritional levels, as complementary therapy to HAART, needed to be considered.

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References

  1. Bunupuradah T, Ubolyam S, Hansudewechakul R, Kosalaraksa P, Ngampiyaskul C, Kanjanavanit S et al. Correlation of selenium and zinc levels to antiretroviral treatment outcomes in Thai HIV-infected children without severe HIV symptoms. Eur J Clin Nutr 2012; 66: 900–905.

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  2. Nhien NV, Khan NC, Yabutani T, Ninh NX, Chung le TK, Motonaka J et al. Relationship of low serum selenium to anemia among primary school children living in rural Vietnam. J Nutr Sci Vitaminol (Tokyo) 2008; 54: 454–459.

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  3. National Institute of Standards and Technology. Physical Measures Laboratory. Basic Atomic Spectroscopic Data. http://physics.nist.gov/PhysRefData/Handbook/Tables/seleniumtable1.htm (accessed on 22 June 2012).

  4. Krittaphol W, Bailey KB, Pongcharoen T, Winichagoon P, Thomson C, Gibson RS . Primary school children from northeast Thailand are not at risk of seleniumdeficiency. Asia Pac J Clin Nutr 2006; 15: 474–481.

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  5. Pilsner JR, Hall MN, Liu X, Ahsan H, Ilievski V, Slavkovich V et al. Associations of plasma selenium with arsenic and genomic methylation of leukocyte DNA in Bangladesh. Environ Health Perspect 2011; 119: 113–118.

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  1. Florida International University, Miami, FL, USA

    A Campa

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  1. A Campa
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Correspondence to A Campa.

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Campa, A. ‘Cutoff point for selenium deficiency’. Eur J Clin Nutr 66, 1277 (2012). https://doi.org/10.1038/ejcn.2012.115

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