Zinc Homeostasis in Premature Infants Does Not Differ Between Those Fed Preterm Formula or Fortified Human Milk

Jalla, Sanju; Krebs, Nancy F.; Rodden, Donna J; Hambidge, K. Michael

doi:10.1203/01.pdr.0000139428.77791.3d

Cited by 14 publications

(10 citation statements)

References 22 publications

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“…Diet supplementation with zinc may limit extrauterine growth retardation (2). The potential benefit of higher zinc intake on growth was suggested by a cross-sectional study showing a direct correlation between daily weight gain and intestinal zinc absorption with a daily intake of w3 mg (44). However, these authors suggested that additional studies should be performed to assess the potential benefit of higher zinc intakes.…”

Section: Discussionmentioning

confidence: 99%

Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country

Terrin¹,

Canani²,

Passariello³

et al. 2013

The American Journal of Clinical Nutrition

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Background: Zinc plays a pivotal role in the pathogenesis of many diseases and in body growth. Preterm neonates have high zinc requirements. Objective: The objective of the study was to investigate the efficacy of zinc supplementation in reducing morbidity and mortality in preterm neonates and to promote growth. Design: This was a prospective, double-blind, randomized controlled study of very-low-birth-weight preterm neonates randomly allocated on the seventh day of life to receive (zinc group) or not receive (control group) oral zinc supplementation. Total prescribed zinc intake ranged from 9.7 to 10.7 mg/d in the zinc group and from 1.3 to 1.4 mg/d in the placebo control group. The main endpoint was the rate of neonates with $1 of the following morbidities: lateonset sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leucomalacia, and retinopathy of prematurity. Secondary outcomes were mortality and body growth. Results: We enrolled 97 neonates in the zinc group and 96 in the control group. Morbidities were significantly lower in the zinc group (26.8% compared with 41.7%; P = 0.030). The occurrence of necrotizing enterocolitis was significantly higher in the control group (6.3% compared with 0%; P = 0.014). Mortality risk was higher in the placebo control group (RR: 2.37; 95% CI: 1.08, 5.18; P = 0.006). Daily weight gain was similar in the zinc (18.2 6 5.6 g $ kg 21 $ d 21 ) and control (17.0 6 8.7 g $ kg 21 $ d 21

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Section: Discussionmentioning

confidence: 99%

Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country

Terrin¹,

Canani²,

Passariello³

et al. 2013

The American Journal of Clinical Nutrition

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“…Unfortunately, the estimated dietary Zn requirements for the preterm infant are relatively high. For example, with the recent Life Sciences Research Office (LSRO) guidelines, the Zn requirement for a 1500-g preterm infant at 33 weeks post-conception approximates that of the 6-to 12-month term infant (ie, approximately 2.5 mg Zn/day 11 or possibly even higher [Krebs 2004;unpublished data]). This intake is substantially in excess of the calculated IA 50 (0.6 mg Zn/day) for this population and is on a part of the saturable response model in which Zn absorption is very inefficient.…”

Section: Discussionmentioning

confidence: 99%

Changes in zinc absorption during development

Hambidge

Krebs

Westcott

et al. 2006

The Journal of Pediatrics

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“…Few data are available for endogenous fecal losses as a potential factor impacting zinc requirements. Our own data indicated relatively high losses, but these must be considered in light of the very high zinc intake [33]. Some inefficiency of reabsorption of intestinal endogenous zinc appeared likely, possibly related to shorter intestinal length, to concurrent fat malabsorption, or to a combination of these or other factors.…”

Section: Acquired Zinc Deficiencymentioning

confidence: 95%

“…Standard fortification levels result in high zinc intakes relative to body weight: 2.7 mg/kg/day, which is more than 4-fold greater than exclusively breastfed term infants at 2 weeks of age [4,33]. As the promotion of human milk in NICUs, either mothers' own or donor milk, has gained momentum, there is potential for more variable and possibly marginal zinc intake if fortification is not assured [34].…”

Section: Acquired Zinc Deficiencymentioning

confidence: 99%

“…Fractional zinc absorption by the premature infant has been reported to be of a similar magnitude to that of older infants, but absorptive capacity appears to be lower, perhaps due to shorter intestinal length [37,38] and/or immaturity of zinc transporters [38]. Several reports indicate high renal losses of zinc in young premature infants [33,39,40]. Diuretics commonly used in this population are likely to further increase zinc losses.…”

Section: Acquired Zinc Deficiencymentioning

confidence: 99%

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Update on Zinc Deficiency and Excess in Clinical Pediatric Practice

Krebs¹

2013

Ann Nutr Metab

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The critical importance of adequate zinc status to human health, including normal growth and development, is indisputable. The high prevalence of zinc deficiency on a global basis and its importance to public health have been well documented through large-scale randomized controlled zinc supplementation trials. Similar evidence in the clinical setting, however, is much less widely available due to the nonspecific features of zinc deficiency and to the lack of sensitive biomarkers to detect zinc deficiency, especially that of a mild degree of severity. The current understanding of zinc homeostasis indicates that the primary determinants of zinc absorption are the amount of zinc ingested and dietary phytate, the latter having a major effect on zinc bioavailability. In normal as well as in many pathologic conditions, the gastrointestinal tract is the major site of zinc losses resulting from secretion of endogenous zinc into the lumen and subsequent excretion in the feces. The amount excreted is dependent on host status, the amount reabsorbed, and sometimes the presence of pathophysiologic conditions, including diarrhea and steatorrhea. Assessment in the clinical setting dictates that the clinician obtain a careful medical and diet history, recognize clinical presentations in which zinc adequacy may be compromised, and link this risk with nonspecific but plausible manifestations of deficiency. Examples discussed in this article include primary zinc deficiency due to dietary inadequacy (older breastfed infants or toddlers without zinc-rich complementary foods); genetically based deficiency (acrodermatitis enteropathica, acquired zinc deficiency of lactogenic origin), and acquired secondary deficiency in low birth weight and prematurity, gastrointestinal and hepatic disease, and cystic fibrosis. Evidence for efficacy of zinc therapy with pharmacologic doses for two conditions, Wilson's disease and viral upper respiratory infections, is also discussed.

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Zinc Homeostasis in Premature Infants Does Not Differ Between Those Fed Preterm Formula or Fortified Human Milk

Cited by 14 publications

References 22 publications

Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country

Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country

Changes in zinc absorption during development

Update on Zinc Deficiency and Excess in Clinical Pediatric Practice

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