Investigating the relationship among zinc status, blood manganese levels, and enzymatic markers of tissue damage: an epidemiological study using NHANES 2013-2016 data

Manganese is an essential trace element required for various physiological processes. However, excessive exposure to this metal can lead to health issues. This study aims to evaluate whether adequate zinc intake can influence the relationship between blood manganese levels and markers indicating damage to the liver and other organs in populations using epidemiological data. We conducted a comprehensive analysis utilizing 2013–2016 data from the National Health and Nutrition Examination Survey (NHANES). The findings indicated that blood manganese exhibits a significant positive association with the serum levels of enzymatic markers of liver damage alkaline phosphatase and aspartate aminotransferase. However, when investigating the interaction between blood manganese and zinc intake at the second quartile, a significant negative association was found with alkaline phosphatase in three different linear regression models. A similar association was found between the fourth quartile of zinc intake and lactate dehydrogenase activity in all three models of the study. The findings suggest that unhealthy high levels of manganese in populations may lead to tissue injury and disease. Nevertheless, having an adequate zinc intake could help mitigate manganese toxicity. [Display omitted] •Blood manganese levels correlated positively with ALP and AST.•Blood manganese correlated negatively with ALP and LDH when accounting for the interaction with zinc intake.•Sufficient zinc intake may help mitigate the effects of elevated blood manganese levels on enzymatic markers of tissue injury.