Recommended reference intervals for copper and zinc in serum using the US National Health and Nutrition Examination surveys (NHANES) data

Background and Aims: In view of the wide variations in reference intervals (RIs) for copper and zinc concen-trations in serum, this study was designed to derive appropriate RIs that could be routinely adopted in other laboratories, so allowing better interpretation of results. A secondary aim was to assess the effects of several variables on serum concentrations of copper and zinc.Materials and Methods: Data from over 21,000 individuals were downloaded from four National Health and Nutrition Examination Surveys conducted by the US Centers for Disease Control and Prevention. After con-trolling for the effects of several variables, age and gender-related RIs were calculated.Results: A comprehensive list of reference intervals of copper and zinc in serum is provided. Serum copper concentrations were affected by age, gender, ethnicity, pregnancy, use of oral contraceptive pill, health status and smoking (in males). Serum zinc concentrations were affected by gender, age, fasting, ethnicity, serum albumin concentration, health status (in males), time of venipuncture and pregnancy.Conclusion: Reliable RIs for copper and zinc in serum were derived. As analytical accuracy and precision were assured and optimal sample collection protocols were followed, these RIs can be transferred for routine use in other clinical biochemistry laboratories with good analytical performance in external quality assurance schemes.