Predominant copper deficiency during prolonged enteral nutrition through a jejunostomy tube compared to that through a gastrostomy tube

Clin Nutr. 2011 Oct;30(5):585-9. doi: 10.1016/j.clnu.2011.04.008. Epub 2011 May 18.


Background & aims: Trace element deficiencies are known to occur during long-term enteral nutrition feeding. We compared the serum concentrations of trace elements between patients treated with gastrostomy and those treated with jejunostomy.

Methods: Our subjects were 36 patients who underwent percutaneous endoscopic gastrostomy (PEG group) and 23 patients who underwent percutaneous endoscopic jejunostomy (PEJ group) and were maintained with enteral tube feeding for more than one year. The serum concentrations of copper, zinc, selenium, and iron were measured in the two groups. Clinical manifestations and the effectiveness of supplementation therapy against copper deficiency were also investigated.

Results: From 6 months after the onset of enteral feeding, the copper concentration of the PEJ group was significantly decreased compared with that of the PEG group (p<0.001). There were no significant differences in the concentrations of zinc, selenium, or iron between the two groups. Severe copper deficiency was observed in 6 patients of the PEJ group and was accompanied with neutropenia and anemia. The copper deficiency was successfully treated in all of these patients by supplementation with 10-40 g of cocoa powder a day which was equivalent to a total daily dose of 1.36-2.56 mg of copper.

Conclusions: Prolonged PEJ tube nutrition tends to result in copper deficiency, and cocoa supplementation is effective for treating such copper deficiency.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anemia / diet therapy
  • Anemia / etiology
  • Cacao / chemistry
  • Copper / administration & dosage*
  • Copper / analysis
  • Copper / blood
  • Copper / deficiency*
  • Enteral Nutrition / adverse effects*
  • Female
  • Food, Formulated / adverse effects*
  • Food, Formulated / analysis
  • Gastrostomy* / adverse effects
  • Humans
  • Iron / blood
  • Jejunostomy* / adverse effects
  • Male
  • Middle Aged
  • Neutropenia / diet therapy
  • Neutropenia / etiology
  • Seeds / chemistry
  • Selenium / blood
  • Severity of Illness Index
  • Time Factors
  • Zinc / blood


  • Copper
  • Iron
  • Selenium
  • Zinc