Zinc Supplementation in Young Children with Acute Diarrhea in India

Sazawal, Sunil; Black, Robert E.; Bhan, Maharaj Kishan; Bhandari, Nita; Sinha, Anju; Jalla, Sanju

doi:10.1056/nejm199509283331304

Cited by 352 publications

(219 citation statements)

References 48 publications

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“…Our results contrast with other studies in which zinc supplementation resulted in reduced incidence or duration of diarrhoea or respiratory infections (Sazawal et al, 1995; but are very similar to reports of morbidity among stunted and non-stunted children in a previous Jamaican study (Grantham-McGregor et al, 1993). The Jamaican population may be less exposed to these illnesses since both the zinc supplemented and the placebo groups showed fairly low rates of morbidity, and the low incidence of many symptoms would contribute to the dif®culty in detecting signi®cant differences between the groups.…”

Section: Discussioncontrasting

confidence: 99%

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Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children

1998

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Objective: We investigated whether there was a growth or morbidity response to zinc supplementation. Design: The study was randomized, placebo-controlled, and double-blind. Setting: Children were recruited at clinics in Kingston, Jamaica, and supplemented at home. Subjects: Children selected were singletons aged 6±24 months, and stunted (`À2.0 s.d. length for age, NCHS references). They were strati®ed by sex and age and randomly assigned to receive zinc supplement (n 31) or placebo (n 30). Four children were excluded because of hospitalization; all others had all measurements. Adequately nourished children (n 24) were recruited from a well-baby clinic. Interventions: The supplement provided 5 mg elemental zinc in a syrup daily for 12 weeks; the placebo comprised the syrup only. Main outcome measures: Caretakers were interviewed to obtain social background data, number of clinic visits and hospitalizations. Anthropometric measurements were done on enrolment, and after 6 weeks, 12 weeks and 12 months. Children's health was determined by weekly questionnaire to caretakers of the undernourished groups during the supplementation period. Results: The supplemented and placebo groups were similar on enrolment. The adequately nourished children were from signi®cantly better socio-economic circumstances. Mean initial hair zinc content was 5.5 AE 4.8 mmolag (supplemented group) and 6.7 AE 12.1 mmolag (placebo)(n.s.). Regression analyses showed that there were no signi®cant effects of supplementation on length, height or head circumference, nor on the incidence of any morbidity symptom. Mean duration of the episodes was signi®cantly shorter for skin rashes in the supplemented group compared with the control group (ANCOVA, P 0.02), and longer for vomiting (P 0.02). The incidence of hospitalization was signi®cantly greater in the control group (Fisher's exact test, P 0.02). Conclusions: Zinc supplementation reduced the hospitalizations which probably re¯ect severity of morbidity, but did not improve growth.

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Section: Discussioncontrasting

confidence: 99%

“…Zinc supplementation reduced the incidence (Sazawal et al, 1996), duration and severity of diarrhoea in children (Sazawal et al, 1995) and had protective effects on diarrhoea and respiratory infections (Black, 1996).…”

Section: Introductionmentioning

confidence: 99%

Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children

1998

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“…Al reported a significant reduction in the incidence and prevalence of acute and persistent diarrhoea with zinc and multivitamin supplementation in Indian children. 17 M K Bhan et.al zinc supplementation had no effect in children of 6-11 months old. 25 In children >11 months, there was significantly less diarrhoea in the zinc group.…”

Section: Discussionmentioning

confidence: 98%

“…14,15 The beneficial effects of zinc and vitamin A administration as combination too have been emphasized by some of the studies. 16,17 However, the effects of vitamin A alone in this condition is controversial with some studies stressing its importance and some studies showing that vitamin A actually increases symptoms. 18,19 A number of studies have shown that there is no difference in supplementation with zinc or vitamin A in combination or alone.…”

Section: Discussionmentioning

confidence: 99%

Serum zinc levels and effect of zinc and vitamin A supplementation in children with diarrhea: a randomized control study

Kalvakuri

Nalisetty

2017

Int J Contemp Pediatr

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Background: Zinc deficiency affects about two billion people in the developing world and is associated with many diseases. Zinc is crucial for normal development and function of cells mediating nonspecific immunity such as neutrophils and natural killer cells. Zinc supplementation has been shown to be effective for preventing diarrhea in children. Vitamin A helps to regulate the immune system, which helps to prevent or fight off infections by making white blood cells that destroy harmful bacteria and viruses. Methods: In this randomized control study 82 children aged 6months to 5 years were randomized 52 in the group of acute diarrhoea and 30 in the control group. Blood samples were drawn for estimation of serum zinc levels. Children in the acute diarrhoea group 23 received zinc alone and 23 received zinc and vitamin A and followed up for 6 months. Results: The serum zinc levels were significantly lower in children with acute diarrhea (66.7µg/dl) as compared to that of the children in the control group (80.5433 µg/dl) (p=<0.001). The children with malnourishment had a mean zinc level that was significantly lesser (p=<0.01). In the acute diarrhea group, children receiving zinc supplementation alone, 10 of the children had at least 1 episode of diarrhea over the next 6 months. Children receiving zinc and vitamin A supplementation, there were only 5 such children with at least 1 episode of acute diarrhea. Conclusions: Combination of zinc and vitamin A supplementation in acute diarrhea decreases the chances of recurrence of diarrhoea and reduces the hospital stay significantly.

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“…1993), although in some developing countries where the zinc status is likely to be very poor, even higher doses may be necessary (Gibson, 1994;Sazawal et al 1995). During pregnancy, preventive doses of 20-25mg elemental zinc per day, generally as zinc sulphate, have been most frequently used (Swanson & King, 1987;Tamura & Goldenberg, 1996).…”

Section: Supplementationmentioning

confidence: 99%

Nutrition intervention strategies to combat zinc deficiency in developing countries

Gibson

Ferguson

1998

Nutr. Res. Rev.

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Widespread zinc deficiency is likely to exist in developing countries where staple diets are predominantly plant based and intakes of animal tissues are low. The severe negative consequences of zinc deficiency on human health in developing countries, however, have only recently been recognized. An integrated approach employing targeted supplementation, fortification and dietary strategies must be used to maximize the likelihood of eliminating zinc deficiency at a national level in developing countries. Supplementation is appropriate only for populations whose zinc status must be improved over a relatively short time period, and when requirements cannot be met from habitual dietary sources. As well,

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Zinc Supplementation in Young Children with Acute Diarrhea in India

Abstract: For infants and young children with acute diarrhea, zinc supplementation results in clinically important reductions in the duration and severity of diarrhea.

Cited by 352 publications

References 48 publications

Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children

Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children

Serum zinc levels and effect of zinc and vitamin A supplementation in children with diarrhea: a randomized control study

Nutrition intervention strategies to combat zinc deficiency in developing countries

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