Mohammad Javad Eslami - Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Mehri Khoshhali - Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
Roya Kelishadi - Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.

Objectives: This study aims to assess the zinc deficiency prevalence in Iran during the past two decades and compare it with other countries. Methods: We searched PubMed, Google Scholar, Web of Sciences, Scientific Information Database (SID), and Magiran for English and Persian reports on zinc deficiency prevalence in Iran. The search terms were “zinc”, zinc deficiency”, “low zinc level”, “low zinc concentration”, “prevalence”, “epidemiology”, “status”, “Iran”, “Iranian”, and “Persian”, using Boolean operators ‘AND’ or ‘OR.’ The preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist were applied during the review. Two authors reviewed the articles independently. We included all articles published from ۲۰۰۱ to ۲۰۲۱ that reported zinc deficiency prevalence based on serum zinc levels (μg/dL) in the Iranian population. We excluded clinical intervention studies and studies on pregnant women, children with stunting or malnutrition, and patients with a particular disease. The effect sizes of prevalence rates were extracted from original studies. Meta-analysis with the random-effects model was used to estimate the pooled prevalence of zinc deficiency. Publication bias was evaluated by Egger’s test and the Funnel plot. Results: This systematic review and meta-analysis included ۲۰ studies (۱۲ for males, ۱۳ for females, and ۱۸ for both that involved ۱۶۱۳۸ participants; ۸۴۲۴ males and ۹۰۵۳ females). Using the random effect model, the overall prevalence of zinc deficiency in the general population was ۱۶% (۹۵% CI, ۱۱%-۲۰%), and in males and females, ۱۸.۴% (۹۵% CI, ۰.۱۲%-۰.۲۴%) and ۱۵% (۹۵% CI, ۱۰%-۲۰%), respectively. In subgroup analysis, the prevalence rates of zinc deficiency for ۶ years old children and adolescents were ۲۹% and ۱۲%, respectively.  Conclusions: The overall prevalence of zinc deficiency in the Iranian population was ۱۶%, lower than the ۲۰% set by IZiNCG (the International Zinc Nutrition Consultative Group) to indicate the need for national intervention programs. However, the COVID-۱۹ pandemic and climate changes threaten this fragile margin. Dietary diversification/modifications, supplementation programs, fortification, and bio-fortification can be used to minimize the problem in high-risk populations. Since this study evaluates the adult healthy population of Iran, we should be cautious about generalizing its results on other population groups like children.

Zinc deficiency, Iran, Prevalence