Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials

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

doi:10.1093/ajcn/72.6.1516

Cited by 424 publications

(189 citation statements)

References 30 publications

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“…Zn is effective in the treatment of diarrhoea; in a recent meta-analysis a reduction in the duration and severity of acute and persistent diarrhoea is confirmed (44) . Zn also gives a 42 (95 % CI 10, 63) % reduction in treatment failure or death from diarrhoea (45) . Zn supplementation is now recommended by the WHO alongside oral rehydration salts during treatment of acute diarrhoea in children.…”

Section: Zincmentioning

confidence: 99%

Nutrition, intestinal defence and the microbiome

Kelly

2010

Proc. Nutr. Soc.

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The interaction between nutrition and infection was the subject of important work by several groups in the 1960s. The explosion of knowledge in immunology, including innate immunity, has led to increased understanding of the impact of nutrition on host defence, but much more work needs to be done in this area. In the last decade an increasing volume of work has opened up the previously obscure world of human endogenous flora. This work suggests that the microbiome, the total genetic pool of the microbiota, contributes to the already complex interaction between nutrition and infectious disease. The established concept that nutritional status, host defence and infection all impact on each other now has to be expanded into a multiple interaction, with the microbiota interacting with all three other elements. There is good evidence that the microbiome programmes host defence and drives a metabolome that impacts on energy balance, and indeed on some micronutrients. In turn, host defence shapes the microbiome, and nutritional status, particularly micronutrient status, helps determine several elements of host defence. While interventions in this area are in their infancy, the understanding of interactions that already have an enormous impact on global health is now at a threshold. The present review explores the evidence for these interactions with a view to putting potential interventions into the context of a conceptual framework.

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Section: Zincmentioning

confidence: 99%

Nutrition, intestinal defence and the microbiome

Kelly

2010

Proc. Nutr. Soc.

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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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“…Zinc supplementation in children has been associated with reductions in morbidity from infectious diseases, especially diarrhoeal and respiratory infections (Bhutta et al, 2000), and zinc supplementation during pregnancy reduced the incidence and prevalence of diarrhoeal disease in low birth weight newborns (Osendarp et al, 2001). Surprisingly, two large trials of iron and zinc supplementation in children failed to find a significant beneficial effect of zinc supplementation on mortality in children under the age of 12 months (Sazawal et al, 2007;Tielsch et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Maternal micronutrient supplementation with zinc and β-carotene affects morbidity and immune function of infants during the first 6 months of life

Wieringa

Dijkhuizen

Muhilal³

et al. 2010

Eur J Clin Nutr

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Background/Objectives: Micronutrient deficiencies are prevalent worldwide, and a major cause of infant death. Supplementation with multiple micronutrients during pregnancy might improve micronutrient status of the newborn, thereby reducing morbidity and death. Moreover, maternal supplementation might affect the newborn's immune development. Therefore, this study investigated the effects of maternal zinc and b-carotene supplementation on the infant's morbidity and immune function during the first 6 months of life. Subjects/Methods: Mothers were supplemented during pregnancy with b-carotene and/or zinc, in addition to iron and folic acid, in a randomized, double-blind controlled trial. Newborn infants (n ¼ 136) were followed up for 6 months. Results: Infants born from mothers receiving zinc during pregnancy had significantly fewer episodes of diarrhoea than infants born from mothers not receiving zinc (0.2 and 0.4, respectively), but more episodes of cough (1.3 and 0.9 respectively) during the first 6 months. Maternal b-carotene supplementation had no effect on infants' morbidity. Cytokine production in the newborns was affected by maternal zinc and b-carotene supplementation, with zinc supplementation giving higher interleukin-6 production (16% higher), and b-carotene supplementation leading to lower interferon-g production (36% lower). Conclusions: This study shows that maternal supplementation with zinc and b-carotene affected the newborn's immune development in specific ways, but only maternal zinc supplementation significantly affected morbidity in the infants. Addition of zinc to routine iron and folic acid supplements for pregnant women could be an effective way to reduce diarrhoeal disease during the first 6 months of life, albeit at the expense of more episodes of cough.

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Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials

Abstract: Zinc supplementation reduces the duration and severity of acute and persistent diarrhea.

Cited by 424 publications

References 30 publications

Nutrition, intestinal defence and the microbiome

Nutrition, intestinal defence and the microbiome

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

Maternal micronutrient supplementation with zinc and β-carotene affects morbidity and immune function of infants during the first 6 months of life

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