Impact of zinc supplementation on subsequent growth and morbidity in Bangladeshi children with acute diarrhoea

Abstract

Objective: To assess the impact of zinc supplementation during acute diarrhoea on subsequent growth and morbidity in malnourished young children. Design: Double blind randomized controlled clinical trial Setting: International Centre for Diarrhoeal Disease Research, Bangladesh. Subjects: Sixty-®ve children aged 3 ± 24 months with acute diarrhoea for less than 3 d. Intervention: Either elemental zinc (20 mgad) in a multivitamin syrup or multivitamin syrup alone divided in three divided daily doses for a period of two weeks. Children were followed up weekly at home to assess subsequent growth and morbidity for a period of eight weeks. Main outcome measures: Gain in length and body weight and reduction in diarrhoea and respiratory tract infection. Results: During the follow-up, zinc supplemented children showed signi®cantly greater cumulative length gain (18.9 mm vs 14.5 mm, P`0.03) and comparable body weight gain than the children of the control group. Subsequent length gain was not correlated with initial height in the zinc-supplemented group (r À0.13), P 0X5), but was signi®cantly correlated in the control group (r À0X6, P`0.0007). Zinc-supplemented and stunted children ( 907 length for age n 18) experienced signi®cantly fewer episodes of diarrhoea (0.07 vs 0.6, P`0X05) and respiratory illness (1.0 vs 2.4, P`0.01) compared to the control group. The underweight children ( 717 weightaage n 38) receiving zinc-supplementation also had fewer episodes of diarrhoea (0.4 vs 1.0, P`0.04) and shorter duration of diarrhoeal episodes (1.0 vs 3.0 d, P`0.04) compared to their counterparts in the control group. Conclusion: These results suggest that a short course of zinc supplementation to malnourished children during acute diarrhoea reduces growth-faltering and diarrhoeal and respiratory morbidity during subsequent two months.

Zinc supplementation in the management of shigellosis in malnourished children in Bangladesh

“…In this study, zinc supplementation reduced the number of diarrhoeal episodes during the 6-month follow-up, which corroborates the findings of our earlier studies on short-term zinc supplementation during acute diarrhoea (Roy et al, 1999) and persistent diarrhoea (The Zinc Investigators' Collaborative Group, 2000; Roy et al, 2007). This effect could have resulted from immunological and nutritional benefits of zinc supplementation, better mucosal repair and growth (Alam et al, 1994).…”

“…However, in our study the beneficial effect of zinc on growth, as observed during hospitalization, was not sustained during the follow-up period. This could result from one or more of the following: relatively shorter duration of zinc supplementation to overcome the strong catabolic effects of shigellosis, which was not adequate for sustained growth thereafter, but reported earlier (Roy et al, 1999) and significant enteric protein and micronutrient loss in stool during acute-stage diarrhoea (Castillo-Duran et al, 1988;Bennish et al, 1993).…”

“…Zinc supplementation has been shown to enhance linear growth in malnourished children with acute and persistent diarrhoea (Roy et al, 1999(Roy et al, , 2007 and improved intestinal permeability in children with shigellosis (Alam et al, 1994). Zinc supplementation had a significant preventive effect on the incidence of persistent diarrhoea and dysentery in certain groups of preschool children (Sazawal et al, 1996).…”

Zinc Deficiency: Descriptive Epidemiology and Morbidity among Preschool Children in Peri-urban Population in Delhi, India

“…There is evidence to show preventive and therapeutic effects of zinc supplementation on various childhood morbidities (18,(25)(26)(27)(28)(29)(30). Our morbidity-related results showed that children with zinc deficiency were at a higher risk of morbidities compared to zinc-sufficient children.…”

Undernutrition, infection and immune function

“…There are now a number of studies showing that Zn supplementation decreases the incidence of childhood diarrhoea (Ninh et al 1996;Sazawal et al 1996Sazawal et al , 1998Rosado et al 1997;Roy et al 1997Roy et al , 1999Ruel et al 1997) and respiratory illness (Ninh et al 1996;Sazawal et al 1998;Roy et al 1999). However, some studies fail to show bene®t of Zn supplementation in respiratory disease (Bates et al 1993;Rosada et al 1997;Ruel et al 1997;Lira et al 1998).…”