A randomized controlled clinical trial of zinc, vitamin A or both in undernourished children with persistent diarrhea in Bangladesh

Abstract

Khatun UHF, Malek MA, Black RE, Sarkar NR, Wahed MA, Fuchs G, Roy SK. A randomized controlled clinical trial of zinc, vitamin A or both in undernourished children with persistent diarrhea in Bangladesh. Acta Paediatr 2001; 90: 376-380. Stockholm ISSN 0803-5253 In a double-blind randomized controlled clinical trial, moderately malnourished Bangladeshi children (61-75% of the median weight/age) were studied for the effect of zinc and/or vitamin A supplementation on the clinical outcome of persistent diarrhea. Children 6 mo to 2 y of age with diarrhea for more than 14 d were randomly allocated into 4 groups of 24 receiving a multivitamin syrup and (i) zinc (20 mg elemental), (ii) vitamin A, (iii) both zinc and vitamin A, or (iv) neither, in 2 doses daily for 7 d. Clinical data on recovery and on stool output, consistency and frequency were recorded for 7 d, and weight change from day 1 to day 7 was assessed. The baseline characteristics of the four study groups were comparable. The mean daily stool outputs from days 2 to 7 of therapy were signi cantly less in the zinc and zinc plus vitamin A groups, but not in the vitamin A group, in comparison with the control group. In children receiving zinc, the cumulative stool weight in the 7 d was 39% less than in the control group (p < 0.001) and 32% less than in the vitamin A group (p = 0.006). The cumulative stool weight in the zinc plus vitamin A group was 24% less than in the control group (p < 0.001), but the 14% lower output than in the vitamin A group was not statistically different. The change in body weight over the 7 d study period was signi cantly different between the group receiving zinc and the control group ( ‡111 g vs ¡90 g, p = 0.045). The rate of clinical recovery of children within 7 d was signi cantly greater in the zinc group (88%) compared with the control group (46%, p = 0.002) or vitamin A group (50%, p = 0.005), but not statistically different from the zinc plus vitamin A group (67%, p = 0.086). Conclusion:The results indicate that zinc, but not vitamin A, supplementation in persistent diarrhea reduces stool output, prevents weight loss and promotes earlier recovery.

Functional Indicators for Assessing Zinc Deficiency

“…Outcomes assessed were diarrhea duration, stool frequency, stool weight, and stool volume. Zinc-supplemented children had better diarrhea outcomes in three of the five trials [23,24,26]. All zincsupplemented children received at least two times the RDA during the treatment period.…”

“…Five trials have assessed zinc supplementation in children with persistent diarrhea [23][24][25][26][27] (table 1). One trial was conducted in Peru, and four were conducted in South Asia.…”

The Effect of Therapeutic Zinc Supplementation among Young Children with Selected Infections: A Review of the Evidence

“…Studies eligible for inclusion were randomized, controlled trials that assessed the adjunctive therapeutic benefits of zinc supplementation in children under 5 years of age with persistent diarrhea. The search identified five studies [29][30][31][32][33] All groups received a multivitamin syrup The mean daily stool outputs from days 2 to 7 of therapy were significantly less in the zinc and zinc plus vitamin A groups, but not in the vitamin A group, in comparison with the control group. The rate of clinical recovery of children within 7 days was significantly greater in the zinc group (88%) than in the control group (46%, p = .002) and the vitamin A group (50%, p = .005) but was not significantly different from that in the zinc plus vitamin A group (67%, p = .086) NCHS, National Center for Health Statistics…”

Scale-up Zinc Sulphate Use for Management of Childhood Diarrheal Diseases in Zambia Through Community Health Workers and Women’s Support Groups

“…From the articles retrieved in our search, it shows that zinc supplementation, given alone, reduces drastically the duration and severity of acute or persistent diarrhea (16,17,22,23,24,25). Associated with other additional information from other published randomized trials, these results indicate that zinc can have substantial clinical benefit and suggest that this supplementary therapy could reduce morbidity and mortality from diarrhea (16, 18, 19 and 23).…”