Oral zinc supplementation in persistent diarrhoea in infants

Sachdev, H. P. S.; Mittal, Naveen K; Yadav, Harsh

doi:10.1080/02724936.1990.11747411

Cited by 54 publications

(39 citation statements)

References 18 publications

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“…Several studies examined the therapeutic effects of zinc on persistent diarrhea. Again, the first study on this topic was conducted by Sachdev et al in India (16). This was a hospital-based inpatient study of children 6-18 mo of age (average age 9 mo).…”

Section: Therapeutic Effects Of Zinc On Diarrheamentioning

confidence: 99%

Therapeutic and preventive effects of zinc on serious childhood infectious diseases in developing countries

Black

1998

The American Journal of Clinical Nutrition

193

106

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In children in developing countries, zinc deficiency may be common and associated with immune impairment and increased risk of serious infectious diseases such as diarrhea, pneumonia, and malaria. Studies have evaluated the therapeutic effects of zinc supplementation during acute or persistent diarrhea. In studies of acute diarrhea, the illness duration has been found to be 9-23% shorter in zinc-supplemented than in control children. Diarrhea was also less severe in zinc-supplemented children. In studies of persistent diarrhea, the effect sizes were similar but were often not statistically significant, perhaps because of the small number of children participating in these studies. Trials that provided continuous daily zinc supplementation for 5-15 mo evaluated effects on the incidence of diarrhea and in some studies acute lower respiratory infections and malaria. The reduction in the incidence of diarrhea in the zinc-supplemented group in these studies ranged from 8% to 45%. A study that gave 2 wk of zinc supplementation found preventive effects against diarrhea for the 3 mo of surveillance. More limited data also suggest that the incidence of acute lower respiratory infection and clinical attacks of malaria may also be reduced by zinc supplementation. If these results are confirmed by meta-analysis of the existing trials and additional research, improvement of zinc nutriture should become a priority intervention to reduce the high burden of serious infectious disease in children in developing countries.Am J Clin Nutr 1998;68(suppl):476S-9S.

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Section: Therapeutic Effects Of Zinc On Diarrheamentioning

confidence: 99%

Therapeutic and preventive effects of zinc on serious childhood infectious diseases in developing countries

Black

1998

The American Journal of Clinical Nutrition

193

106

View full text Add to dashboard Cite

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“…In conclusion, the addition of zinc directly to an ORS may operate in several possible ways: a) by providing a readily absorbable form of zinc to zinc-depleted tissues, where zinc may also act as an antiinflammatory agent (27)(28)(29)(31)(32)(33)(34)(35)(36); 2) by introducing antioxidant organometallic complexes (42,43,(45)(46)(47), capable of inducing MT synthesis in the enterocyte (48,49); or c) by scavenging NO diffusing out of the enterocyte, especially under conditions of increased NO synthesis, thus creating a NO gradient toward the intestinal lumen. …”

Section: Resultsmentioning

confidence: 99%

“…This connection was first inferred from reports of low plasma zinc in children with diarrhea (27,28). More recently, it has been shown that serum and rectal biopsy zinc concentrations are decreased in children and infants with chronic diarrhea (29). Also, considerable zinc losses have been reported in children with acute dehydrating diarrhea (30).…”

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confidence: 99%

Zinc as a Potential Enteroprotector in Oral Rehydration Solutions: Its Role in Nitric Oxide Metabolism

et al. 2003

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Zinc has been recognized as an antioxidant with potential for chronic and acute effects. Oxidative damage produced by free radicals, including nitric oxide (NO), is responsible for certain types of intestinal malabsorption syndromes and diarrhea. Under physiologic or mildly stimulatory conditions for NO synthesis, the small intestine characteristically is in a proabsorptive state; however, an excessive production of NO triggers formation of cyclic nucleotides, which cause secretion and malabsorption. In this study, we hypothesized that low-molecular-weight, soluble zinc chelates could modulate the effects of induced NO excess on the small intestine. In vitro experiments demonstrated that zinccitrate or zinc-histidine at Ն0.66 mM, as well as a known NO scavenger, 2-[carboxyphenyl]-4,4,4,4-tetramethylimidazoline-1-oxyl-3-oxide, at 2 M, were effective at removing chemically generated NO. In vivo jejunal perfusions, conducted in healthy rats under anesthesia, showed that c-PTIO reduced the proabsorptive effects produced by 1 mM L-arginine, the precursor of NO. In a standard oral rehydration solution, 1 mM zinc-citrate partially reversed the antiabsorptive effects on potassium caused by an excess of NO generated from 20 mM L-arginine but did not alter sodium or water absorption. The data are consistent with the view that soluble zinc compounds incorporated into an oral rehydration solution may deserve further attention as a means to scavenge NO with fluids used for the treatment of chronic or acute diarrhea, especially in malnourished children who are often zinc deficient. The importance of NO as a second messenger has become fully recognized in the last several years, especially in regard to endothelial tissue responses to endogenous stimuli (1). A reduction of NO synthesis from Arg in endothelia may lead to cell contraction, increased vascular protein leakage, and inflammation (2, 3). The latter may be linked to free radical formation. The severity of chronic ileitis has been associated with the extent of NO synthesis by inducible NO synthase (iNOS) in the intestine (4). This may play a role on the integrity of the mucosal barrier, compromised in that condition. Proinflammatory cytokines up-regulate iNOS, as experimentally shown in chemically induced colitis injury (5), after injection of IL-1␣ (6) and in cancer patients receiving IL-2 (7). Animal and human studies support the view that zinc has anti-inflammatory properties. In rats with 2,4,6-trinitrobenzenesulfonic acid-induced colitis, zinc sulfate enemas produced a decrease in the lesion area and in other markers of inflammation (8). In another context, zinc ions have been considered an important anti-inflammatory factor because they appear to block human rhinovirus docking on intercellular adhesion molecule-1 (ICAM-1) on somatic cells, thus interrupting the inflammatory process (9). Experiments on rats injected with lipopolysaccharide (LPS) to induce inflammation showed that endogenous zinc inhibited LPS or IL-1-induced NO formation, as well as reduced the act...

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“…Zinc supplementation has also been shown to have a therapeutic effect on diarrhea episodes, especially persistent diarrhea, in several hospital-based studies in which malnourished children or children with diarrhea had been admitted (18)(19)(20)(21)(22)(23)(24). The effect of zinc supplementation could depend on nutritional status, on age, and, of course, on zinc status at admission.…”

Section: Introductionmentioning

confidence: 99%