Zinc combined with vitamin A reduces upper respiratory tract infection morbidity in a randomised trial in preschool children in Indonesia

Abstract

<jats:p>Zn supplementation has shown inconsistent effects on respiratory morbidity in young children in developing countries. Few studies have focused on upper respiratory tract infection (URTI), a frequent cause of morbidity in this group, and potential benefit from Zn supplementation or factors that influence its efficacy. We investigated the effects of Zn supplementation on URTI before and after vitamin A supplementation. This randomised double-blinded controlled Zn supplementation study was conducted on 826 children aged 2–5 years. Placebo or Zn (10 mg/d) was given in syrup daily for 4 months, with 200 000 IU vitamin A (60 mg retinol) given to all children at 2 months. Health workers visited children every 3 d for compliance and morbidity information. We found that 84 % of children experienced URTI during the study. Zn supplementation reduced the percentage of days with URTI (12 % reduction;<jats:italic>P</jats:italic> = 0·09), with greater impact following vitamin A supplementation (20 % reduction;<jats:italic>P</jats:italic> = 0·01). Vitamin A supplementation was associated with a decreased number but an increased duration of URTI episodes. We conclude that Zn combined with vitamin A supplementation significantly reduced the percentage of days with URTI in a population of preschool Indonesian children with marginal nutritional status. The results suggest that vitamin A status modifies the efficacy of Zn supplementation on URTI.</jats:p>

Household Food Insecurity is Associated with Respiratory Infections Among 6–11-Month Old Infants in Rural Ghana

“…21 In Indonesia, vitamin A supplementation on the first day of life resulted in a lower incidence of respiratory infections that demanded medical treatment (14.2% vs. 24.6%; P = 0.008) among infants at 4 months of age, 19 and vitamin A supplementation was associated with a significant reduction (23% reduction, P < 0.001) in the number of respiratory tract infections among preschool children. 20 Although an earlier study showed that almost a third of infants in the study area (32.2%) did not meet the vitamin A requirement from complementary foods (Ohemeng A, unpublished data, 2012), Ghana has a vitamin A supplementation program for children 6-59 months that is conducted twice annually with a coverage rate of 93% as at 2010. 22 Thus, inadequate vitamin A status may not be a pathway that could explain the observed association between HHFI and symptoms of respiratory infections in this population.…”

“…18 Inadequate diets that are low in vitamin A have been associated with increased risk of respiratory infections, and supplementation studies among deficient infants and young children showed reduced prevalence of illness. 19,20 Vitamin A maintains the integrity of the epithelium in the respiratory tract, thus playing an important role in reducing infections. 21 In Indonesia, vitamin A supplementation on the first day of life resulted in a lower incidence of respiratory infections that demanded medical treatment (14.2% vs. 24.6%; P = 0.008) among infants at 4 months of age, 19 and vitamin A supplementation was associated with a significant reduction (23% reduction, P < 0.001) in the number of respiratory tract infections among preschool children.…”

Comparison of Zinc,Vitamin A &D Serum Levels Between Children With Respiratory Tract Infection And Healthy Individuals in two Iranian Referral Hospitals

“…On the other hand, cartasuria et al investigated the effects of adding zinc to diet before and after adding vitamin A to diet of children between 2-5 years old in Indonesia. He concluded that supplementary zinc and vitamin A in preschool children diminished the number of days with respiratory infection (46). Bhutta and colleagues found out that adding zinc to children younger than 5 years' diet reduces the prevalence of pneumonia (8).…”

Micronutrient Deficiencies: Impact on Therapeutic Outcomes

“…A recent randomized controlled trial compared zinc supplementation or placebo with vitamin A, in 852 apparently healthy 2-5 year-old children in Indonesia, on the incidence and duration of upper respiratory tract infections (URTI) over 4 months [ 63 ]. Children in the study were randomized to receive either 10 mg of elemental zinc ( n = 399) or placebo ( n = 399) daily in syrup for four months.…”