Zinc, Vitamin A, and Micronutrient Supplementation in Children with Diarrhea: A Randomized Controlled Clinical Trial of Combination Therapy versus Monotherapy

Dutta, P; Mitra, U; Naik, T. N.; Rajendran, K.; Chatterjee, Mrinal Kanti

doi:10.1016/j.jpeds.2011.03.028

Cited by 24 publications

(23 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eight trials did not report the definition of acute diarrhoea (Sachdev 1988; Roy 1997; Larson 2005;Fajolu 2008; Shimelis 2008; Patel 2009; Patro 2010; Jiang 2016). …”

Section: Resultsmentioning

confidence: 99%

Oral zinc for treating diarrhoea in children

Lazzerini

Wanzira

2016

Cochrane Database of Systematic Reviews

172

View full text Add to dashboard Cite

Background In developing countries, diarrhoea causes around 500,000 child deaths annually. Zinc supplementation during acute diarrhoea is currently recommended by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). Objectives To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (the Cochrane Library 2016, Issue 5), MEDLINE, Embase, LILACS, CINAHL, m RCT, and reference lists up to 30 September 2016. We also contacted researchers. Selection criteria Randomized controlled trials (RCTs) that compared oral zinc supplementation with placebo in children aged one month to five years with acute or persistent diarrhoea, including dysentery. Data collection and analysis Both review authors assessed trial eligibility and risk of bias, extracted and analysed data, and drafted the review. The primary outcomes were diarrhoea duration and severity. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CI). Where appropriate, we combined data in meta‐analyses (using either a fixed‐effect or random‐effects model) and assessed heterogeneity. We assessed the certainty of the evidence using the GRADE approach. Main results Thirty‐three trials that included 10,841 children met our inclusion criteria. Most included trials were conducted in Asian countries that were at high risk of zinc deficiency. Acute diarrhoea There is currently not enough evidence from well‐conducted RCTs to be able to say whether zinc supplementation during acute diarrhoea reduces death or number of children hospitalized ( very low certainty evidence ). In children older than six months of age, zinc supplementation may shorten the average duration of diarrhoea by around half a day (MD −11.46 hours, 95% CI −19.72 to −3.19; 2581 children, 9 trials, low certainty evidence ), and probably reduces the number of children whose diarrhoea persists until day seven (RR 0.73, 95% CI 0.61 to 0.88; 3865 children, 6 trials, moderate certainty evidence ). In children with signs of malnutrition the effect appears greater, reducing the duration of diarrhoea by around a day (MD −26.39 hours, 95% CI −36.54 to −16.23; 419 children, 5 trials, high certainty evidence ). Conversely, in children younger than six months of age, the available evidence suggests zinc supplementation may have no effect on the mean duration of diarrhoea (MD 5.23 hours, 95% CI −4.00 to 14.45; 1334 children, 2 trials, low certainty evidence ), or the num...

show abstract

“…Eight trials did not report the definition of acute diarrhoea (Sachdev 1988; Roy 1997; Larson 2005;Fajolu 2008; Shimelis 2008; Patel 2009; Patro 2010; Jiang 2016). …”

Section: Resultsmentioning

confidence: 99%

Oral zinc for treating diarrhoea in children

Lazzerini

Wanzira

2016

Cochrane Database of Systematic Reviews

172

View full text Add to dashboard Cite

show abstract

“…Study characteristics are shown in Table 1 (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46). Only three studies had a population of fewer than 100 patients, and all studies were conducted in countries considered to be "emerging and developing economies" (48).…”

Section: Resultsmentioning

confidence: 99%

Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis

Galvão

Silva²,

Pontes³

et al. 2013

Rev Panam Salud Publica

View full text Add to dashboard Cite

Galvao TF, Thees MFRS, Pontes RF, Silva MT, Pereira MG. Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis. Rev Panam Salud Publica. 2013;33(5):370-7. Suggested citationZinc supplementation for treating diarrhea in children: a systematic review and meta-analysis Results. Eighteen of 1 041 studies retrieved were included in the review (n = 7 314 children). Zinc was beneficial for reducing the duration of diarrhea in hours (mean difference [MD] = -20.12, 95% confidence interval [CI] = -29.15 to -11.09, I² = 91%). The effect was greater in malnourished children

show abstract

“…There is some suggestion [13] that zinc gluconate may be the most effective, but it also causes more vomiting. Some studies have combined zinc with other potentially deficient micronutrients such as vitamin A, but this did not confer additional advantage [35]. Copper has also been added because of concern that zinc can reduce copper, but in a trial in India, there was no therapeutic benefit from the zinc supplement with or without copper [36].…”

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

“…There is some suggestion that doses of 20 mg are more effective in the younger age group [18]. Some positive trials have given ≥40 mg elemental zinc [6,20,35] with success and without apparent adverse effects, but taken together, there is no evidence that higher doses of zinc are related to greater reduction in duration of diarrhea [14]. Higher doses may be associated with increased vomiting and one study that gave 3 mg/kg/day of zinc found a significant reduction in serum copper levels after 2 weeks of supplementation [38].…”

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

Zinc Supplementation in Public Health

Penny

2013

Ann Nutr Metab

View full text Add to dashboard Cite

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.

show abstract

Zinc, Vitamin A, and Micronutrient Supplementation in Children with Diarrhea: A Randomized Controlled Clinical Trial of Combination Therapy versus Monotherapy

Cited by 24 publications

References 22 publications

Oral zinc for treating diarrhoea in children

Oral zinc for treating diarrhoea in children

Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis

Zinc Supplementation in Public Health

Contact Info

Product

Resources

About