Short-Course Prophylactic Zinc Supplementation for Diarrhea Morbidity in Infants of 6 to 11 Months

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Randomized controlled trials have shown that zinc supplementation during diarrhea substantially reduces the incidence and severity. However, the effect of short-course prophylactic zinc supplementation has been observed only in children .12 months of age. WHAT THIS STUDY ADDS:The current study was able to show that short-course prophylactic zinc supplementation significantly reduced diarrhea morbidity in apparently healthy infants of 6 to 11 months even after 5 months of follow-up. abstract BACKGROUND: Zinc supplementation during diarrhea substantially reduces the incidence and severity of diarrhea. However, the effect of short-course zinc prophylaxis has been observed only in children .12 months of age. Because the incidence of diarrhea is comparatively high in children aged 6 to 11 months, we assessed the prophylactic effect of zinc on incidence and duration of diarrhea in this age group. METHODS:In this randomized, double-blind, placebo-controlled trial, we enrolled infants aged 6 to 11 months from an urban resettlement colony in Delhi, India, between January 1, 2011, and January 15, 2012. We randomly assigned 272 infants to receive either 20 mg of zinc or a placebo suspension orally every day for 2 weeks. The primary outcome was the incidence of diarrhea per child-year. All analyses were done by intention-to-treat. RESULTS:A total of 134 infants in the zinc and 124 in the placebo groups were assessed for the incidence of diarrhea. There was a 39% reduction (crude incident rate ratio [IRR] 0.61, 95% confidence interval [CI] 0.53-0.71) in episodes of diarrhea, 39% (adjusted IRR 0.61, 95% CI 0.54-0.69) in the total number of days that a child suffered from diarrhea, and reduction of 36% in duration per episode of diarrhea (IRR 0.64, 95% CI 0.56-0.74) during the 5 months of follow-up.CONCLUSIONS: Short-course prophylactic zinc supplementation for 2 weeks may reduce diarrhea morbidity in infants of 6 to 11 months for up to 5 months, in populations with high prevalence of wasting and stunting. Pediatrics 2013;132:e46-e52 AUTHORS:

Daily Zinc but Not Multivitamin Supplementation Reduces Diarrhea and Upper Respiratory Infections in Tanzanian Infants: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial,

“…However, weekly zinc supplementation for 12 mo was found effective in reducing the incidence of diarrhea and pneumonia among urban Bangladeshi infants aged 2-12 mo (19). Similarly, a study in Delhi, India, involving infants 6-11 mo of age, reported that a short course of daily zinc supplementation for 2 wk effectively reduced the subsequent number and duration of diarrhea episodes (20). In contrast, a multicenter study involving infants 1-5 mo of age with acute diarrhea found that infants who received therapeutic zinc supplementation for 14 d had more days of diarrhea and similar prevalence of pneumonia and respiratory infection compared with the placebo group (21).…”

Efficacy of zinc sulfate supplement on febrile seizure recurrence prevention in children with normal serum zinc level: A randomised clinical trial

“…The most common adverse events of zinc are nausea and abdominal pain and side effects such as diarrhea, vomiting, and constipation have been reported. The majority of these gastrointestinal side effects of zinc sulphate or acetate in children are uncommon and mild, and can be handled by dosage change or spontaneous disappearance, and zinc sulphate is considered to be generally safe and welltolerated [23][24][25][26].…”

Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country

“…We used higher zinc doses; the use of zinc doses above the dietary guidance level is an emerging research area in pediatric nutrition (10,16). Many studies suggest that 10-20 mg Zn/d is able to limit the risk of infections in children (40)(41)(42). Total zinc intake in the zinc group ranged from 9.7 to 10.7 mg/d.…”

“…Serum concentrations of zinc or other vitamins were not measured to avoid adjunctive procedures and blood collections in preterm infants at high risk of iatrogenic anemia and to minimize handling (46,47). The high dose of zinc used during this trial was established on the basis of previous evidence (18,19,(40)(41)(42), whenever the zinc in the placebo group was administered at the low end of the recommended range. Further studies are probably advocated to establish the optimal dose of zinc in this particular population.…”