Toward revising dietary zinc recommendations for children aged 0 to 3 years: a systematic review and meta-analysis of zinc absorption, excretion, and requirements for growth

Abstract

Context The Food and Agriculture Organization of the United Nations and the World Health Organization are updating their dietary zinc recommendations for children aged 0 to 3 years. Objective The aim of this review was to retrieve and synthesize evidence regarding zinc needs for growth as well as zinc losses, absorption, and bioavailability from the diet. Data Sources MEDLINE, Embase, and Cochrane Library databases were searched electronically from inception to August 2020. Studies assessing the above factors in healthy children aged 0 to 9 years were included, with no limits on study design or language. Data Extraction Ninety-four studies reporting on zinc content in tissue (n = 27); zinc absorption (n = 47); factors affecting zinc bioavailability (n = 30); and endogenous zinc losses via urine, feces, or integument (n = 40) met the inclusion criteria. Four reviewers extracted data and two reviewers checked for accuracy. Data Analyses Studies were synthesized narratively, and meta-analyses of zinc losses and gains as well the subgroups of age, type of feeding, country’s income, and molar ratio of phytate to zinc were conducted. Meta-analysis revealed an overall mean (95%CI) urinary and endogenous fecal zinc excretion of 17.48 µg/kg/d (11.80–23.15; I2 = 94%) and 0.07 mg/kg/d (0.06–0.08; I2 = 82%), respectively, with a mean fractional zinc absorption of 26.75% (23.69–29.81; I2 = 99%). Subgrouping by age revealed differences in mean values associated with the transition from milk-based diets to solid food during the first 3 years of life. Conclusion This review synthesizes data that may be used to formulate zinc requirements in young children. Results should be interpreted with caution because of considerable heterogeneity in the evidence. Systematic Review Registration PROSPERO registration number CRD42020215236.

Zinc Supplementation Trial in Pediatric Chronic Kidney Disease: Effects on Circulating FGF-23 and Klotho

“…A recent meta-analysis showed that an overall mean (95% confidence interval [CI]) urinary and endogenous fecal zinc excretion of 17.48 µg/kg/d (11.80-23.15; I 2 = 94%) and 0.07 mg/kg/d (0.06-0.08; I 2 = 82%), respectively, with a mean fractional zinc absorption of 26.75% (23.69-29.81; I 2 = 99%) indicated primarily bowel excretion of zinc. 12 Thus, the safety of zinc supplementation in CKD children should not be significantly different from other children without kidney disease. Upper tolerable levels of daily zinc intake likely to pose no risk of adverse health effects in almost all individuals are 12 mg for 4- to 8-year-olds, 23 mg for 9- to 13-year-olds and 34 for 14- to 18-year-olds.…”

Preventing and Controlling Zinc Deficiency Across the Life Course: A Call to Action

“…Whereas for a refined or mixed (animal- and vegetable-based) diet, the PA:Zn molar ratio is < 5, and the fraction of zinc absorbed is ≤50% [ 83 ]. Therefore, alongside increasing dietary zinc intake, it is important to reduce the PA:Zn molar ratio to improve zinc bioavailability without affecting other consumer preferences [ 84 ].…”

Calcium, zinc, and vitamin D in breast milk: a systematic review and meta-analysis

“…Calcium, zinc and vitamin D are essential nutrients during infancy and early childhood for growth and health [ 3 – 5 ]. Breast milk is a source of calcium and zinc and, in small amounts, of vitamin D for infants and young children.…”