Zinc Supplementation for One Year Among Children with Cystic Fibrosis Does Not Decrease Pulmonary Infection

Abstract

BACKGROUND: Children with cystic fibrosis may have a deficiency of micronutrients, including zinc, which may affect their susceptibility to infections. There is a paucity of data on zinc supplementation among children with cystic fibrosis. We hypothesized that a pharmacologic dose of zinc administered daily for 12 months would reduce the need for antibiotics by 50%. METHODS: This double-blind randomized placebo-controlled trial was conducted among children with cystic fibrosis to assess the effect of zinc supplementation on the need for antibiotics and pulmonary function tests. The children, age 5-15 y, of either sex, received either 30-mg zinc tablets or similar looking placebo tablets daily in addition to standard care. They were followed up every month for a period of 12 months and whenever they had pulmonary exacerbations. Their serum zinc was estimated at baseline and at 12 months of enrollment. During each visit, the children underwent a pulmonary function test and sputum culture. RESULTS: Of a total of 43 children screened, 40 were enrolled, and of them, 37 completed the study. The median (interquartile range) number of days of the administration of antibiotics over 12 months of follow-up among the children receiving zinc was 42 (14 -97) d. In the placebo group, it was 38 (15-70) d (P ‫؍‬ .79). There were no significant differences in the percent-of-predicted FEV 1 or change in FEV 1 values at 12 months (P ‫؍‬ .44). The number of children in whose respiratory specimens Pseudomonas was isolated was similar for the 2 groups at different time intervals. The adverse events reported were similar in the 2 groups. CONCLUSION: We did not find any significant difference in the need for antibiotics, pulmonary function tests, hospitalization, colonization with Pseudomonas, or the need for antibiotics for children with cystic fibrosis receiving zinc supplementation of 30 mg/d.

Zinc Nutritional Status in Patients with Cystic Fibrosis

“…Even though data on zinc supplementation among children with cystic fibrosis are limited [33,57,73,92,93], the ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adult with CF suggest zinc supplementation for people who are at risk of zinc insufficiency [1]. At present, despite contradictory findings, many researchers believe that the intake of 30 mg/day of zinc reduces the number of days of antibiotics used to treat respiratory tract infections in these children [73].…”

“…In spite of the fact that Sharma et al in a double-blind randomized placebo-controlled, the study of zinc supplementation in 37 children with CF (age 5–15 y) did not find any significant difference in the need for antibiotics, pulmonary function tests, hospitalization, colonization with pseudomonas, or the need for antibiotics. They highlighted that the majority of the children had low serum zinc levels at baseline; therefore, the dose of zinc administered may not have been sufficient to have an impact on the outcomes [92]. Conversely, Abdulhamid et al conducted a double-blind randomized controlled small trial in which 26 children were treated with placebo or zinc (30 mg/day) for one year.…”

Efeitos da suplementação de zinco na função Pulmonar de pacientes pediátricos com fibrose cística: uma revisão sistemática / Effects of zinc supplementation on pulmonary function of pediatric patients with cystic fibrosis: a systematic review

“…Traçando um paralelo com a dosagem utilizada para a suplementação de Zn nos estudos incluídos nesta revisão, em dois deles 11,12 os valores administrados (30mg/d) ultrapassaram o limite superior tolerável de maior ingestão (UL) em algumas faixas etárias. Outro estudo 10 , que suplementa 1,14 mg Zn/kg/dia, também pode ultrapassar a UL, a depender do peso do paciente.…”

Cystic fibrosis year in review 2016

“…Supplementation with zinc, a micronutrient that is commonly deficient in CF, has previously been associated with an increased risk of infection. However, a double‐blind, randomized, placebo‐controlled study of zinc supplementation in patients 5‐15 years of age for 12 months showed no difference in number of days on antibiotics, lung function, or isolation of PA …”