Prevalence of low serum zinc concentrations in Indian children and adolescents: findings from the Comprehensive National Nutrition Survey 2016–18

Abstract

Background It is thought that there is a high risk of zinc deficiency in India, but there are no representative national estimates. Objectives We aimed to evaluate the national and state-level prevalence of low serum zinc concentrations (SZCs) in Indian children from the nationally representative Comprehensive National Nutrition Survey. Methods Prevalence of low SZC, adjusted for C-reactive protein, was estimated among preschool (1–4 y; n = 7874) and school-age children (5–9 y; n = 10,430) and adolescents (10–19 y; n = 10,140), using SZC cutoffs defined by the International Zinc Nutrition Consultative Group. Results Prevalence of low SZC was high among adolescents (31.1%; 95% CI: 29.8%, 32.4%), compared with school-age (15.8%; 95% CI: 15.3%, 16.3%) or preschool children (17.4%; 95% CI: 16.7%, 18.0%). However, stratification of prevalence by fasting status or using an alternative lower SZC cutoff independent of fasting status led to a reduction in prevalence by 3.7% or 7.8% in children <10 y, respectively. The prevalence of low SZC was higher among rural preschool children, those belonging to households with poor socioeconomic status, and those with severe stunting or underweight. Preschool children with diarrhea (22.6%; 95% CI: 20.8%, 24.4%), productive cough (22.7%; 95% CI: 18.5%, 27.5%), or malaria/dengue (38.5%; 95% CI: 29.4%, 48.2%) in the 2 wk preceding the survey had a higher prevalence of low SZC than those without morbidity (16.5%; 95% CI: 15.9%, 17.2%; 17.6%; 95% CI: 16.9%, 18.2%; and 17.5%; 95% CI: 16.8%, 18.1%, respectively). Conclusions The national prevalence of low SZC among preschool (17%) or school-age children (16%) was <20%, which is considered the cutoff indicating a problem of public health significance; but there were variations by state and socioeconomic status. In adolescents, however, the prevalence of low SZC was 31%, which warrants further investigation. The association of low SZC with diarrhea in preschool children necessitates better coverage of Zn administration in the management of diarrhea.

Association of dietary intake with micronutrient deficiency in Indian school children: a cross-sectional study

“…Some of the studies have reported that peer influences, availability and access to ready to eat energy-dense food, nutrient poor convenience foods at homes, schools, and urban neighbourhoods and eye-catching repeated commercials on fast foods in mass media, perhaps are the undesirable influencers on food habits of children and adolescents in urban India. ( 22 ) The above factors were not studied but likely to exist and may have contributed to children developing unhealthy food habits leading to micronutrient deficiencies. Further studies are needed in this area.…”

Assessment of zinc inadequacy among tribal adolescent population of central India - A cross-sectional study

“…Low serum zinc in schoolchildren (6-15 yr) has been reported to be more than 83 per cent in our neighbouring country Nepal 24 , and in Cameroon 25 , the prevalence of low serum zinc is reported to be 82 per cent in women (15-49 yr). Comprehensive National Nutrition Survey (CNNS) 2016-18 provides estimates of serum zinc deficiency in adolescents 6 . As per the survey report, nearly 32 per cent of the adolescents in India and nearly 20 per cent adolescents in MP were found to have low serum zinc.…”

“…Adolescence is another crucial stage in growth and development, and therefore, zinc deficiency could be detrimental in such stage of life. During adolescence, higher prevalence of inadequate zinc intake 4 and low serum zinc (ranging from 30 to 98%) have been reported 5 , 6 . Studies among tribal adolescent and non-adolescent populations have also reported higher prevalence 7 , 8 .…”

A risk-based approach to measuring population micronutrient status from blood biomarker concentrations

“…The data for this analysis were obtained from the Comprehensive National Nutrition Survey (CNNS) ( 6 ) a cross-sectional, nationally representative survey of Indian children and adolescents, which was conducted in 30 states of India between 2016 and 2018, under the aegis of the Ministry of Health and Family Welfare, Government of India, in collaboration with United Nations International Children's Emergency Fund (UNICEF), India and the Population Council, Delhi, India. The survey design and sampling methodology are already published elsewhere ( 6 – 8 ). Briefly, a multi-stage, population proportional to size cluster sampling was done to enroll preschool (1–4 years), school age (5–9 years) children, and adolescents (10–19 years), to adequately represent the national, state, male-female, and urban-rural population.…”