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nutrientsArticleSelenium Def i ciency in Lymphedema andLipedema—A Retrospective Cross-Sectional Studyfrom a Specialized ClinicChristina Pf i ster1, *, Horst Dawczynski 1and Franz-Josef Schingale21Biosyn Arzneimittel GmbH, Schorndorfer Straße 32, 70734 Fellbach, Germany; horst_dawczynski@biosyn.de2Lympho Opt Fachklinik, Happurger Straße 15, 91224 Hohenstadt, Germany;franz-josef.schingale@lympho-opt.de* Correspondence: chpf i ster@t-online.de; Tel.: +49-711-57532-321Received: 26 March 2020; Accepted: 24 April 2020; Published: 25 April 2020????????? ????????Abstract: Background: Selenium is a trace element, which is utilized by the human body inselenoproteins. Their main function is to reduce oxidative stress, which plays an important role inlymphedema and lipedema. In addition, selenium def i ciency is associated with an impaired immunefunction. The aim of this study was to determine the prevalence of selenium def i ciency in theseconditions, and if it is associated with disease severity and an associated medical condition suchas obesity. Methods: This cross-sectional study is an anonymized, retrospective analysis of clinicaldata that was routinely recorded in a clinic specialized in lymphology. The data was comprisedfrom 791 patients during 2012–2019, in which the selenium status was determined as part of theirtreatment. Results: Seleniumdef i ciencyprovedcommoninpatientswithlymphedema, lipedema, andlipo-lymphedema af f ecting 47.5% of the study population. Selenium levels were signif i cantly lowerin patients with obesity-related lymphedema compared to patients with cancer-related lymphedema(96.6 ± 18.0 µ g/L vs. 105.1 ± 20.2 µ g/L; p < 0.0001). Obesity was a risk factor for selenium def i ciencyin lymphedema (OR 2.19; 95% CI 1.49 to 3.21), but not in lipedema. Conclusions: In countrieswith low selenium supply, selenium def i ciency is common, especially in lymphedema patients.Therefore, it would be sensible to check the selenium status in lymphedema patients, especially thosewith obesity, as the infection risk of lymphedema is already increased.Keywords: selenium; lymphedema; lipedema; obesity; oxidative stress; inf l ammation1. IntroductionClinics specialized in lymphological diseases manage not only patients with cancer treatment-related secondary lymphedema, but also treat patients with primary lymphedema, as well as secondarylymphedema due to obesity, lipedema, or lipo-lymphedema. The pathogenesis of lymphedema is aprogressive process, consisting of lymphatic leakage and stagnation, chronic inf l ammation, adiposetissue expansion and f i brosis [ 1 ]. In contrast to lymphedema, lipedema is characterized by bilaterallyincreased circumference of extremities, pain sensation, and bruising [ 2 ]. Lipedema leaves most distalparts of the body, i.e., hands and feet, unaf f ected. In early stages, lipedema shows increased lymphaticf l ow, not lymphatic insuf f i ciency [ 3 ]. The tissue water content in lipedema patients is in the range ofhealthy controls [ 4 ]. However, patients with lipedema may develop secondary lymphedema, if thefatty deposits compromise the lymphatic system [ 5 ]. The combination of lipedema and lymphaticimpairment is called lipo-lymphedema [6].Secondary lymphedema is mostly associated with cancer treatment as common and debilitatingprogressive sequelae. Recently, another reason has come to the fore: obesity-related lymphaticNutrients 2020, 12, 1211; doi:10.3390/nu12051211 www.mdpi.com/journal/nutrients