Randomised controlled trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhoea

Abstract

Objective-To evaluate the impact of zinc supplementation on the clinical course, stool weight, duration of diarrhoea, changes in serum zinc, and body weight gain of children with acute diarrhoea. Design-Randomised double blind controlled trial. Children were assigned to receive zinc (20 mg elemental zinc per day) containing multivitamins or control group (zinc-free multivitamins) daily in three divided doses for two weeks. Setting-A diarrhoeal disease hospital in Dhaka, Bangladesh. Patients-111 children, 3 to 24 months old, below 76% median weight for age of the National Center for Health Statistics standard with acute diarrhoea. Children with severe infection and/or oedema were excluded. Main outcome measures-Total diarrhoeal stool output, duration of diarrhoea, rate of weight gain, and changes in serum zinc levels after supplementation. Results-Stool output was 28% less and duration 14% shorter in the zinc supplemented group than placebo (p = 0.06). There were reductions in median total diarrhoeal stool output among zinc supplemented subjects who were shorter (less than 95% height for age), 239 v 326 g/kg (p < 0.04), and who had a lower initial serum zinc (< 14 mmol/l), 279 v 329 g/kg (p < 0.05); a shortening of mean time to recovery occurred (4.7 v 6.2 days, p < 0.04) in those with lower serum zinc. There was an increase in mean serum zinc in the zinc supplemented group (+2.4 v −0.3 µmol/l, p < 0.001) during two weeks of supplementation, and better mean weight gain (120 v 30 g, p < 0.03) at the time of discharge from hospital. Conclusions-Zinc supplementation is a simple, acceptable, and aVordable strategy which should be considered in the management of acute diarrhoea and in prevention of growth faltering in children specially those who are malnourished.

Zinc supplementation in the management of shigellosis in malnourished children in Bangladesh

“…The findings indicate that zinc supplementation resulted in faster recovery from diarrhoea; the 50% shorter median duration of illness as observed in this study is greater than that has been observed in our earlier studies in young children with acute watery diarrhoea, (Roy et al, 1997) and persistent diarrhoea (Roy et al, 1998;The Zinc Investigators' Collaborative Group, 2000) and cholera (Roy et al, 2006a).…”

“…An earlier Bangladeshi study had also observed significant increase in the mean body weight of children with acute diarrhoea who received zinc (Roy et al, 1997). Another Jamaican study observed increase in the lean tissue mass of children during their nutritional rehabilitation (Golden and Golden, 1981).…”

Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis

“…Study characteristics are shown in Table 1 (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46). Only three studies had a population of fewer than 100 patients, and all studies were conducted in countries considered to be "emerging and developing economies" (48).…”

Effectiveness of zinc supplementation plus oral rehydration salts for diarrhoea in infants aged less than 6 months in Haryana state, India

“…This element stabilizes the cell membrane, and zinc deficiency disrupts the intestinal mucosa, reduces brush border enzymes and increases mucosal permeability and the intestinal secretion of water. 17,18 Zinc also acts as a potassium channel blocker, inhibiting cyclic adenosine monophosphate-mediated chlorine secretion. 19 Zinc supplementation during diarrhoea can therefore reduce the severity and duration of the episode.…”