Zinc Supplementation in Public Health

Abstract

Zinc is necessary for physiological processes including defense against infections. Zinc deficiency is responsible for 4% of global child morbidity and mortality. Zinc supplements given for 10-14 days together with low-osmolarity oral rehydration solution (Lo-ORS) are recommended for the treatment of childhood diarrhea. In children aged ≥6 months, daily zinc supplements reduce the duration of acute diarrhea episodes by 12 h and persistent diarrhea by 17 h. Zinc supplements could reduce diarrhea mortality in children aged 12-59 months by an estimated 23%; they are very safe but are associated with an increase in vomiting especially with the first dose. Heterogeneity between the results of trials is not understood but may be related to dose and the etiology of the diarrhea infection. Integration of zinc and Lo-ORS into national programs is underway but slowly, procurement problems are being overcome and the greatest challenge is changing health provider and caregiver attitudes to diarrhea management. Fewer trials have been conducted of zinc adjunct therapy in severe respiratory tract infections and there is as yet insufficient evidence to recommend addition of zinc to antibiotic therapy. Daily zinc supplements for all children >12 months of age in zinc deficient populations are estimated to reduce diarrhea incidence by 11-23%. The greatest impact is in reducing multiple episodes of diarrhea. The effect on duration of diarrheal episodes is less clear, but there may be up to 9% reduction. Zinc is also efficacious in reducing dysentery and persistent diarrhea. Zinc supplements may also prevent pneumonia by about 19%, but heterogeneity across studies has not yet been explained. When analyses are restricted to better quality studies using CHERG (Child Health Epidemiology Reference Group) methodology, zinc supplements are estimated to reduce diarrheal deaths by 13% and pneumonia deaths by 20%. National-level programs to combat childhood zinc deficiency should be accelerated.

Preparation and Preliminary Evaluation of 63Zn-Zinc Citrate as a Novel PET Imaging Biomarker for Zinc

“…Potential applications for PET imaging of zinc dynamics in a broad spectrum of diseases (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) motivates the development of a practical method for producing 63 Zn. Of the 3 known positronemitting zinc isotopes, 63 Zn has the most favorable properties for quantitative PET imaging in humans (Table 1), although its 38.5-m half-life will limit investigations to under 2-3 h. Nevertheless, this time frame is sufficient to determine initial biodistribution patterns of zinc after intravenous injection and evaluation of fast to moderate tissue turnover times.…”

“…Briefly, it consisted of a 1.6-mL water-cooled tantalum target insert that was separated from the cyclotron by dual foils (aluminum and Havar [Goodfellow]) with a helium cooling channel in between. Incident proton energy was degraded from 16.4 2 O and 12 mL of concentrated nitric acid were added to sufficient water to bring the total volume to 1.8 mL. The concentration of HNO 3 (;0.1N) was sufficient to prevent in-target precipitation of copper hydroxide while reducing water radiolysis (13).…”

“…It participates in the tertiary, quaternary, and quinary structure of proteins; in protein aggregation; and in the structure of protein domains for interactions with other proteins, DNA/RNA, and lipids. Zinc deficiency affects about 2 billion people in the developing world (2), whereas excess zinc consumption can also cause detrimental effects of ataxia, lethargy, and copper deficiency. Disruption of zinc homeostasis may be involved in metabolic syndrome, diabetes, and diabetic complications (3).…”

The Efficacy of Elemental Zinc on Acute Diarrhea in Egyptian Infant and Children

“…Infants under 6 months: 10 mg elemental zinc (5 ml) daily. Children above 6 months: 20 mg elemental zinc (10 ml) daily in two divided doses [13].…”

Overview of Inherited Zinc Deficiency in Infants and Children

“…In fact, zinc is essential for growth and development, immune, nervous system and endocrinal functions, and, in particular, is required during the first years of the life when the body is growing rapidly. Hence, in developing countries, where malnutrition is common, zinc deficiency is still a health problem; zinc deficiency increases the risk of morbidity and mortality of young children (1,2). In these countries, zinc supplementation in infants and children can prevent and reduce the severity of common diseases such as diarrhea, lower respiratory tract infections, and improve linear growth velocity.…”