Impact of Different Strategies for Delivering Supplemental Zinc on Selected Fecal Markers of Environmental Enteric Dysfunction among Young Laotian Children: A Randomized Controlled Trial

Abstract

. The objective of this study was to assess the impact of different strategies for delivering supplemental zinc on fecal myeloperoxidase (MPO), neopterin (NEO), and calprotectin (CAL) among young Laotian children. In a double-blind controlled trial, children aged 6–23 months were randomized to receive either daily preventive zinc (PZ) tablets (7 mg/day), daily micronutrient powder (MNP; containing 10 mg zinc and 14 other micronutrients), therapeutic zinc (TZ) supplements for diarrhea treatment (20 mg/day for 10 days), or daily placebo powder and followed for ∼36 weeks. Stool samples were collected at baseline and endline. Fecal MPO, NEO, and CAL concentrations were determined in a randomly selected subsample of 720 children using commercially available ELISA kits. At baseline, the mean age was 14.1 ± 4.9 months and prevalence of stunting was 39%. The endline prevalence of stunting was 43%; there was no overall treatment effect on physical growth in the parent trial. At endline, the mean (95% CI) MPO in the PZ group was 1,590 [1,396; 1,811] ng/mL and did not differ from that in the MNP (1,633 [1,434; 1,859] ng/mL), TZ (1,749 [1,535; 1,992] ng/mL), and control (1,612 [1,415; 1,836] ng/mL) groups ( P = 0.749). Similarly, there was no overall treatment effect on NEO and CAL concentrations ( P = 0.226 and 0.229, respectively). In this population, the provision of PZ or TZ supplements or MNP had no impact on growth or environmental enteric dysfunction (EED) as assessed by fecal MPO, NEO, and CAL. Additional research is needed to better understand the etiology and proposed mechanisms of EED pathogenesis.

Stool biomarkers as measures of enteric pathogen infection in infants from Addis Ababa informal settlements

“…The differences in agreement between the mRNA transcript and stool protein markers suggests that mRNA transcripts and protein biomarkers may measure responses that differ physiologically and temporally. Though at the protein level infants appeared broadly similar to populations reported elsewhere [9,15,[45][46][47], the differences between our study and previously reported studies at the transcript level may indicate that responses to stressors vary by geography and population even though the end result is broad systemic inflammation. Specific biomarker panels to measure both specific cellular and physiologic processes and relevant EED endpoints will be especially valuable in the establishing causality of the inflammatory end-states.…”

Daily preventive zinc supplementation increases the antibody response against pathogenic Escherichia coli in children with zinc insufficiency: a randomised controlled trial

“…Children aged 6–23 months were randomly assigned to one of these interventions in a community-based intervention trial for approximately 9 months. The parent studies examined child growth, diarrhoeal morbidity and the haematologic and micronutrient statuses 16 – 23 . PZ and MNP supplementation significantly increased the plasma zinc concentration compared with the control and TZ groups, but there was no impact on growth or overall diarrhoea burden 19 .…”