Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: Pooled analysis of randomized controlled trials

Bhutta, Zulfiqar A; Black, Robert E.; Brown, Kenneth H.; Gardner, Julie Meeks; Gore, Sheila M.; Hidayat, Adi; Khatun, Fahmida; Martorell, Reynaldo; Ninh, Nguyen Xuan; Penny, Mary E.; Rosado, Jorge L.; Roy, Shantanu; Ruel, Marie T.; Sazawal, Sunil; Shankar, Anuraj H.

doi:10.1016/s0022-3476(99)70086-7

Cited by 630 publications

(372 citation statements)

References 30 publications

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“…Our study would support that the slight but significant negative effect of iron on SZn, when zinc and iron were given together, would have a stronger negative effect on weight gain. Because no treatment had a significant different effect on morbidity, the effect of zinc on weight gain could not be explained by a beneficial effect of zinc on morbidity as demonstrated in children in developing countries (Bhutta et al, 1999). And iron supplementation was not associated with increase susceptibility to infection that confirms previous observations (Berger et al, 2000;Gera and Sachdev, 2002).…”

Section: Discussionsupporting

confidence: 77%

“…As a result, most infants develop iron deficiency anemia (IDA) by 1 year of age (Fairweather-Tait, 1992) and suffer from growth retardation, delayed development and cognitive function and increased morbidity related to infections (Bhutta et al, 1999;Beard and Stoltzfus, 2001).…”

Section: Introductionmentioning

confidence: 99%

“…Zinc supplementation is associated with improvement of growth (Brown et al, 2002) and has beneficial effects on diarrhea and pneumonia morbidity (Bhutta et al, 1999). The importance of these two micronutrient deficiencies in public nutrition and their likely coexistence in infants in developing countries support that combined supplementation with both iron and zinc would be appropriate and would improve the cost-effectiveness of interventions.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants

et al. 2005

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Objective: To evaluate the effect of combined iron-zinc supplementation on micronutrient status, growth and morbidity. Design: Randomized, double-masked, placebo-controlled supplementation trial. Setting: Rural district of Que Vo, in the Red River Delta in Vietnam. Subjects: A total of 915 breast-fed infants aged 4-7 months were included and 784 completed the study. Interventions: The Fe-group received daily and for a 6-month period 10 mg of iron, the Zn-group 10 mg zinc, the Fe-Zn group 10 mg iron þ 10 mg zinc and the placebo group a placebo. Hemoglobin (Hb), serum ferritin (SF) and zinc (SZn), and anthropometry were measured before and at the end of the intervention. Morbidity was recorded daily. Results: Changes of Hb and SF were higher in both Fe and Fe þ Zn groups (respectively 22.6 and 20.6 g/l for Hb; 36.0 and 24.8 mg/l for SF) compared to Zn and placebo groups (Hb: 6.4 and 9.8 g/l; SF: À18.2 and À16.9 mg/l, Po0.0001). SZn increased more in Zn group (10.3 mmol/l) than in Fe þ Zn group (8.0 mmol/l, P ¼ 0.03) and more in these groups compared to Fe and placebo groups (1.6 and 1.2 mmol/l, Po0.0001). Weight gain was higher in the Zn group. No significant effects of supplementations on growth in length or morbidity. Conclusions: Combined iron-zinc supplementation had a positive effect on iron and zinc status in infants. However, the positive effect of zinc alone on SZn and weight would indicate a negative interaction of iron when added to zinc supplements. Sponsorship: UNICEF New York.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants

et al. 2005

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“…Multiple adverse effects of zinc deficiency have been described at various levels of the immune system, including impairments in lymphopoiesis, T-cell development and performance, thymic function, and humoral responses (Shankar and Prasad, 1998). Consistently, zinc supplementation has proven efficacious in decreasing child morbidity from diarrheal and respiratory infections (Bhutta et al, 1999(Bhutta et al, , 2000.…”

Section: Introductionmentioning

confidence: 99%

Zinc supplementation to HIV-1-infected pregnant women: Effects on maternal anthropometry, viral load, and early mother-to-child transmission

et al. 2006

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Objective: To examine the effect of zinc supplementation to HIV-1-infected pregnant women on viral load, early mother-tochild transmission of HIV (MTCT), and wasting. Design: Double-blind placebo-controlled randomized clinical trial. Setting: Antenatal clinic in Dar es Salaam, Tanzania. Subjects: Four hundred HIV-1-infected pregnant women. Methods: Women 12-27 weeks of gestation were randomly assigned to receive a daily oral dose of 25 mg zinc or placebo from the day of the first prenatal visit until 6 weeks postdelivery. Weight and mid-upper arm circumference (MUAC) were measured monthly. HIV status of the babies was assessed at birth and at 6 weeks postpartum. Viral load was assessed in a random sample of 100 women at baseline and at the end of the study. Results: Zinc had no effects on maternal viral load or early MTCT. Supplementation was related to a significant threefold increase in the risk of wasting (reaching a MUAC value o22 cm) during an average 22 weeks of observation (RR ¼ 2.7, 95%CI ¼ 1.1, 6.4, P ¼ 0.03), and to a 4 mm decline in MUAC during the second trimester (P ¼ 0.02). Conclusions: Zinc supplementation to HIV-infected pregnant women offers no benefits on viral load or MTCT. The clinical relevance of an apparent decrease in MUAC associated with zinc supplementation is yet to be ascertained. These findings together with the lack of effect on fetal outcomes (reported previously) do not provide support for the addition of zinc supplements to the standard of prenatal care among HIV-infected women.

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“…It is likely that other micronutrient deficiencies contribute to child morbidity and mortality in sub-Saharan Africa and other settings worldwide. For example, supplements of the trace element zinc significantly reduce the risk of pneumonia and diarrhea among children in developing countries (Bhutta et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Selenium levels in relation to morbidity and mortality among children born to HIV-infected mothers

et al. 2005

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Objective: To examine the relation between selenium status and child mortality and morbidity among children born to HIVinfected mothers. Design: Prospective cohort study. Methods: Study participants were originally part of a trial to study the effect of maternal vitamin supplements on maternal and child health outcomes. Morbidity information was collected during monthly clinic visits until the child reached 24 months of age. Out of 984 livebirths, 806 had morbidity information, and 610 also had data on plasma selenium levels available. Setting: A study clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania, a tertiary-care hospital. Results: The median age at baseline was 10.5 weeks. A total of 117 (19%) of the 610 study children died during follow-up. In a multivariate model, child plasma selenium levels were inversely associated with risk of all-cause mortality (P-value, test for trend ¼ 0.05). Plasma selenium levels were not significantly associated with risk of diarrhea or respiratory outcomes. Conclusions: Among infants born to HIV-infected women in sub-Saharan Africa, selenium status may be important to prevent child mortality. These preliminary findings warrant future reexamination.

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Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: Pooled analysis of randomized controlled trials

Cited by 630 publications

References 30 publications

Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants

Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants

Zinc supplementation to HIV-1-infected pregnant women: Effects on maternal anthropometry, viral load, and early mother-to-child transmission

Selenium levels in relation to morbidity and mortality among children born to HIV-infected mothers

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