copper status change (Turnlund et al., 1997). Above those levels of dietary intake, urinary copper does not respond to increases in dietary copper. In controlled studies, a decline in urinary copper excretion can be used as supporting evidence for inadequate intake.

Leukocyte copper concentration was found to decline along with other indexes of copper status in one study (Turnlund et al., 1997), but it has not been reported in others. Too few data are currently available to use it for establishing dietary recommendations for copper.

Lysyl oxidase activity in the skin, which declined with low dietary copper and increased with repletion, is potentially a useful indicator of copper status (Werman et al., 1997). It is not known if lysyl oxidase activity reflects dietary intake at higher levels of dietary copper in humans. Because data are available from only one study, it cannot yet be used as an indicator for estimating copper requirements.

Peptidyl glycine α-amidating monooxygenase (PAM) activity in serum of rats and stimulation of activity are sensitive indicators of copper intake in the rat (Prohaska et al., 1997). Patients with Menkes’ disease, who have severe copper deficiency due to a metabolic defect in copper transport, had an increased copper stimulation index of plasma PAM as compared with healthy control subjects. This finding suggests that PAM activity may be a useful indicator of copper status in humans when human dose-response data become available.

Two copper supplementation studies demonstrated that the activity of serum diamine oxidase (DAO), another cuproenzyme, increases when supplements containing 2 mg (Jones et al., 1997) and 6 mg (Kehoe et al., 2000) of copper were administered daily, a result that suggests the enzyme may be sensitive to increased dietary copper. It has not yet been studied under conditions of copper