Zinc and other micronutrients supplementation through the use of sprinkles: impact on the occurrence of diarrhea and respiratory infections in institutionalized children

Sampaio, Danile L.B.; Mattos, Ângela Peixoto de; Ribeiro, Tereza Cristina Medrado; Leite, Maria Efigênia de Queiroz; Cole, Conrad R.; Costa-Ribeiro, Hugo

doi:10.1016/j.jped.2012.11.004

Cited by 15 publications

(3 citation statements)

References 19 publications

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“…In contrast, the healthy breastfed-infant comparison group had total zinc absorption adequate to meet their age-specific physiologic requirement of 0.84 mg/d (37) with average intakes of ∼3 mg/d from fortified cereal or meats (28), that is, with intakes well below the lowest MNP zinc dose of 5 mg in the current study. The findings from the current study may at least partially explain the observations of limited benefits of fortification through MNP with 4–5 mg Zn, in contrast to findings for iron-related outcomes with MNP (23, 24).…”

Section: Discussioncontrasting

confidence: 62%

Zinc Absorption from Micronutrient Powders Is Low in Bangladeshi Toddlers at Risk of Environmental Enteric Dysfunction and May Increase Dietary Zinc Requirements

Long

Mondal

Westcott

et al. 2019

The Journal of Nutrition

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BackgroundEnvironmental enteric dysfunction (EED), a chronic inflammatory disorder of the small bowel, is suspected to impair absorption of micronutrients, including zinc.ObjectiveThe objective of this study was to compare zinc absorption from micronutrient powder (MNP) over a range of zinc doses in young children screened for EED with use of the lactulose:mannitol ratio (L:M).MethodsBangladeshi children aged 18–24 mo, grouped according to high and low L:M (≥0.09 and <0.09, respectively), were randomly assigned to MNP with 0, 5, 10, or 15 mg Zn/sachet (10 subjects per dose per L:M group). Over a day, fractional absorption of zinc was measured from an MNP-fortified meal and from unfortified meals with stable isotope tracers; total daily absorbed zinc (TAZ, milligrams per day) was determined as the primary outcome. Secondary outcomes included investigation of relations of TAZ to intake, to physiologic requirement, and to other variables, including biomarkers of systemic and intestinal inflammation, using nonlinear models. TAZ was also compared with published data on child zinc absorption.ResultsIn 74 subjects who completed the study, zinc absorption did not differ by L:M grouping. Most biomarkers of intestinal inflammation were elevated in both L:M groups. For combined L:M groups, mean ± SD TAZ for each MNP dose (0, 5, 10, and 15 mg/sachet) was 0.57 ± 0.30, 0.68 ± 0.31, 0.90 ± 0.43, and 1.0 ± 0.39 mg/d, respectively (P = 0.002), and exceeded the estimated physiologic requirement only for the 10- and 15-mg MNP doses. Zinc absorption was notably lower at all intake levels compared with published data (P < 0.0001) and was inversely related to serum α-1 acid glycoprotein and to fecal Entamoeba histolytica (P = 0.02).ConclusionResults indicate impaired absorption of zinc, which may predispose to zinc deficiency in young children with evidence of enteropathy. These findings suggest that current doses of zinc in MNP may be insufficient to yield zinc-related preventative benefits in similar settings. This study is registered at clinicaltrials.gov as NCT02758444.

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Section: Discussioncontrasting

confidence: 62%

Zinc Absorption from Micronutrient Powders Is Low in Bangladeshi Toddlers at Risk of Environmental Enteric Dysfunction and May Increase Dietary Zinc Requirements

Long

Mondal

Westcott

et al. 2019

The Journal of Nutrition

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“…This is in contrast to a cluster randomised trial among 6-to 18-month-old children in Pakistan, which found that MNP significantly increased the longitudinal diarrhoea prevalence and incidence of bloody diarrhoea (49) . Several other studies also found no difference in diarrhoea or overall morbidity among children who received MNP compared with a control group (50)(51)(52)(53) . However, we found that MNP appeared to have a small beneficial impact on longitudinal diarrhoea prevalence among children without clinically significant IHbD and a small adverse effect among children with IHbD.…”

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confidence: 92%

Iron status and inherited haemoglobin disorders modify the effects of micronutrient powders on linear growth and morbidity among young Lao children in a double-blind randomised trial

et al. 2019

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Some studies found that providing micronutrient powder (MNP) causes adverse health outcomes, but modifying factors are unknown. We aimed to investigate whether Fe status and inherited Hb disorders (IHbD) modify the impact of MNP on growth and diarrhoea among young Lao children. In a double-blind controlled trial, 1704 children of age 6-23 months were randomised to daily MNP (with 6 mg Fe plus fourteen micronutrients) or placebo for about 36 weeks. IHbD, and baseline and final Hb, Fe status and anthropometrics were assessed. Caregivers provided weekly morbidity reports. At enrolment, 55·6 % were anaemic; only 39·3 % had no sign of clinically significant IHbD. MNP had no overall impact on growth and longitudinal diarrhoea prevalence. Baseline Hb modified the effect of MNP on length-for-age (LAZ) (P for interaction = 0·082). Among children who were initially non-anaemic, the final mean LAZ in the MNP group was slightly lower (-1·93 (95 % CI -1·88, -1·97)) v. placebo (-1·88 (95 % CI -1·83, -1·92)), and the opposite occurred among initially anaemic children (final mean LAZ -1·90 (95 % CI -1·86, -1·94) in MNP v. -1·92 (95 % CI -1·88, -1·96) in placebo). IHbD modified the effect on diarrhoea prevalence (P = 0·095). Among children with IHbD, the MNP group had higher diarrhoea prevalence (1·37 (95 % CI 1·17, 1·59) v. 1·21 (95 % CI 1·04, 1·41)), while it was lower among children without IHbD who received MNP (1·15 (95 % CI 0·95, 1·39) v. 1·37 (95 % CI 1·13, 1·64)). In conclusion, there was a small adverse effect of MNP on growth among non-anaemic children and on diarrhoea prevalence among children with IHbD.Anaemia and deficiencies of Fe, iodine, Zn and vitamin A remain public health concerns in many low-income countries (1) . Multiple micronutrient powder (MNP) can be used for pointof-use fortification of foods consumed by young children and are recommended by the WHO to improve Fe status and reduce anaemia among children 6-23 months of age in populations where anaemia is a public health problem (2) . While the evidence for the positive impact of MNP on anaemia and Fe deficiency is consistent (3,4) , two recent meta-analyses of MNP reached different conclusions regarding morbidity outcomes. De Regil et al. (3) found no effect of MNP on diarrhoea (risk ratio 0·97, 95 % CI 0·53, 1·78)), whereas Salam et al. (4) found an increased risk in diarrhoea incidence with MNP (risk ratio 1·04, 95 % CI 1·01, 1·06). Indeed there has been emerging evidence that an increased risk of infection, particularly from diarrhoea and malaria in areas of high transmission, may be associated with Fe supplementation (5) . For young children, WHO recommends MNP containing 10-12·5 mg of elemental Fe, 300 μg retinol and 5 mg of elemental Zn per sachet, with or without other micronutrients, and the provision of ninety sachets for consumption over a 6-month period (2) , though many programmes provide daily doses (6) . To ensure safety, the WHO recommends Abbreviations: IHbD, inherited Hb disorders; Lao PDR, Lao People's Democratic Republic; LAZ, length-f...

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“…There were 26 studies 18,23,26,28,30,34–52 on zinc supplementation, of which 24 were conducted in children (age: 0.45–10 years) Table . In the majority of studies, no significant impact was seen, however, Bhandari et al 2002 35 and Brooks et al 2006 36 showed a positive impact on episodes of pneumonia with zinc supplementation and the studies by Kurugöl et al, 2006, 38 Sanchez et al, 2014, 47 also had a positive impact on the number of common colds and RTIs, respectively.…”

Section: Resultsmentioning

confidence: 99%

Nutrient supplementation for prevention of viral respiratory tract infections in healthy subjects: A systematic review and meta‐analysis

Vlieg‐Boerstra¹,

Jong

Agostoni

et al. 2021

Allergy

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Zinc and other micronutrients supplementation through the use of sprinkles: impact on the occurrence of diarrhea and respiratory infections in institutionalized children

Abstract: Zinc supplementation through the use of sprinkles did not reduce the incidence of DD or ARI among the evaluated children. The sprinkles were well accepted by all study participants.

Cited by 15 publications

References 19 publications

Zinc Absorption from Micronutrient Powders Is Low in Bangladeshi Toddlers at Risk of Environmental Enteric Dysfunction and May Increase Dietary Zinc Requirements

Zinc Absorption from Micronutrient Powders Is Low in Bangladeshi Toddlers at Risk of Environmental Enteric Dysfunction and May Increase Dietary Zinc Requirements

Iron status and inherited haemoglobin disorders modify the effects of micronutrient powders on linear growth and morbidity among young Lao children in a double-blind randomised trial

Nutrient supplementation for prevention of viral respiratory tract infections in healthy subjects: A systematic review and meta‐analysis

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