| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Original Research Communication |
1 From the Aga Khan University Medical Centre, Karachi, Pakistan; the Medical Research Council Biostatistics Unit, Cambridge, United Kingdom; the Johns Hopkins School of Public Health, Baltimore; the University of California, Davis; the University of the West Indies, Mona, Jamaica; Trisakti University, Jakarta, Indonesia; Dhaka Medical College, Dhaka, Bangladesh; Emory University, Atlanta; the National Institute of Nutrition, Hanoi, Vietnam; the Nutrition Research Institute, Lima, Peru; the National Institute of Nutrition, Mexico City; the International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; the Institute of Nutrition of Central America and Panama, Guatemala City; and the All India Institute of Medical Sciences, New Delhi.
Background: Zinc deficiency is prevalent in children in developing countries. Supplemental zinc provides therapeutic benefits in diarrhea.
Objective: We sought to measure the effect of supplemental zinc given with oral rehydration therapy during recovery from acute or persistent diarrhea.
Design: We conducted pooled analyses including all available published and unpublished randomized controlled trials of the effects of supplementary oral zinc in children aged <5 y with acute or persistent diarrhea. We used Cox survival regression analysis to evaluate the overall effect of zinc on continuation of diarrhea and possible differential effects in subgroups divided by sex, age, weight-for-height, and initial plasma zinc concentration. Dichotomous outcomes were analyzed by logistic regression. To assess the effects of excluding studies without original data from the pooled analyses, effect-size was estimated for all studies by using random-effects models.
Results: Zinc-supplemented children had a 15% lower probability of continuing diarrhea on a given day (95% CI: 5%, 24%) in the acute-diarrhea trials and a 24% lower probability of continuing diarrhea (95% CI: 9%, 37%) and a 42% lower rate of treatment failure or death (95% CI: 10%, 63%) in the persistent-diarrhea trials. In none of the subgroup analyses were the 2 subgroups of each pair significantly different from each other; however, in persistent diarrhea there tended to be a greater effect in subjects aged <12 mo, who were male, or who had wasting or lower baseline plasma zinc concentrations.
Conclusion: Zinc supplementation reduces the duration and severity of acute and persistent diarrhea.
Key Words: Diarrhea • diarrheal disease • malnutrition • meta-analysis • randomized controlled trial • zinc • children • infants • developing countries • zinc supplementation • nutrition • zinc deficiency
This article has been cited by other articles:
|
|
 |
|
  N. Bhandari, S. Mazumder, S. Taneja, B. Dube, R. Agarwal, D. Mahalanabis, O. Fontaine, R. E. Black, and M. K. Bhan Effectiveness of Zinc Supplementation Plus Oral Rehydration Salts Compared With Oral Rehydration Salts Alone as a Treatment for Acute Diarrhea in a Primary Care Setting: A Cluster Randomized Trial Pediatrics, May 1, 2008; 121(5): e1279 - e1285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Winch, S. Doumbia, M. Kante, A. Diarra Male, E. Swedberg, K. E. Gilroy, A. A. Ellis, G. Cisse, and B. Sidibe Differential Community Response to Introduction of Zinc for Childhood Diarrhea and Combination Therapy for Malaria in Southern Mali J. Nutr., March 1, 2008; 138(3): 642 - 645. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S K Roy, M J. Hossain, W. Khatun, B. Chakraborty, S Chowdhury, A. Begum, S. Mah-e-Muneer, S. Shafique, M. Khanam, and R Chowdhury Zinc supplementation in children with cholera in Bangladesh: randomised controlled trial BMJ, February 2, 2008; 336(7638): 266 - 268. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lazzerini Zinc supplements for severe cholera BMJ, February 2, 2008; 336(7638): 227 - 228. [Full Text] [PDF]
|
|
|
|
|
|
M. Lukacik, R. L. Thomas, and J. V. Aranda A Meta-analysis of the Effects of Oral Zinc in the Treatment of Acute and Persistent Diarrhea Pediatrics, February 1, 2008; 121(2): 326 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. L Coles, A. Bose, P. D Moses, L. Mathew, I. Agarwal, T. Mammen, and M. Santosham Infectious etiology modifies the treatment effect of zinc in severe pneumonia Am. J. Clinical Nutrition, August 1, 2007; 86(2): 397 - 403. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Aggarwal, J. Sentz, and M. A. Miller Role of Zinc Administration in Prevention of Childhood Diarrhea and Respiratory Illnesses: A Meta-analysis Pediatrics, June 1, 2007; 119(6): 1120 - 1130. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. P. Zwane and M. Kremer What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review World Bank Res. Obs., May 4, 2007; (2007) lkm002v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Hambidge and N. F. Krebs Zinc Deficiency: A Special Challenge J. Nutr., April 1, 2007; 137(4): 1101 - 1105. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L F. Walker, Z. A Bhutta, N. Bhandari, T. Teka, F. Shahid, S. Taneja, R. E Black, and the Zinc Study Group Zinc during and in convalescence from diarrhea has no demonstrable effect on subsequent morbidity and anthropometric status among infants <6 mo of age Am. J. Clinical Nutrition, March 1, 2007; 85(3): 887 - 894. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. T. Wieringa, J. Berger, M. A. Dijkhuizen, A. Hidayat, N. X. Ninh, B. Utomo, E. Wasantwisut, P. Winichagoon, and for the SEAMTIZI (South-East Asia Multi-country Tr Combined Iron and Zinc Supplementation in Infants Improved Iron and Zinc Status, but Interactions Reduced Efficacy in a Multicountry Trial in Southeast Asia J. Nutr., February 1, 2007; 137(2): 466 - 471. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Rosado, P. Lopez, K. Kordas, G. Garcia-Vargas, D. Ronquillo, J. Alatorre, and R. J. Stoltzfus Iron and/or Zinc Supplementation Did Not Reduce Blood Lead Concentrations in Children in a Randomized, Placebo-Controlled Trial J. Nutr., September 1, 2006; 136(9): 2378 - 2383. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Wasantwisut, P. Winichagoon, C. Chitchumroonchokchai, U. Yamborisut, A. Boonpraderm, T. Pongcharoen, K. Sranacharoenpong, and W. Russameesopaphorn Iron and Zinc Supplementation Improved Iron and Zinc Status, but Not Physical Growth, of Apparently Healthy, Breast-Fed Infants in Rural Communities of Northeast Thailand J. Nutr., September 1, 2006; 136(9): 2405 - 2411. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W Sharieff, Z Bhutta, C Schauer, G Tomlinson, and S Zlotkin Micronutrients (including zinc) reduce diarrhoea in children: The Pakistan Sprinkles Diarrhoea Study Arch. Dis. Child., July 1, 2006; 91(7): 573 - 579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K M. Hambidge Zinc and pneumonia Am. J. Clinical Nutrition, May 1, 2006; 83(5): 991 - 992. [Full Text] [PDF]
|
|
|
|
|
|
A. Bose, C. L Coles, Gunavathi, H. John, P. Moses, P Raghupathy, C. Kirubakaran, R. E Black, W A. Brooks, and M. Santosham Efficacy of zinc in the treatment of severe pneumonia in hospitalized children <2 y old Am. J. Clinical Nutrition, May 1, 2006; 83(5): 1089 - 1096. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. WINCH, K. E. GILROY, S. DOUMBIA, A. E. PATTERSON, Z. DAOU, S. COULIBALY, E. SWEDBERG, R. E. BLACK, and O. FONTAINE PRESCRIPTION AND ADMINISTRATION OF A 14-DAY REGIMEN OF ZINC TREATMENT FOR CHILDHOOD DIARRHEA IN MALI. Am J Trop Med Hyg, May 1, 2006; 74(5): 880 - 883. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P Boran, G Tokuc, E Vagas, S Oktem, and M K Gokduman Impact of zinc supplementation in children with acute diarrhoea in Turkey Arch. Dis. Child., April 1, 2006; 91(4): 296 - 299. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. T.-T. Edejer, M. Aikins, R. Black, L. Wolfson, R. Hutubessy, and D. B Evans Cost effectiveness analysis of strategies for child health in developing countries BMJ, November 19, 2005; 331(7526): 1177. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W A. Brooks, M. Santosham, S. K Roy, A. S. Faruque, M A. Wahed, K. Nahar, A. I Khan, A F. Khan, G. J Fuchs, and R. E Black Efficacy of zinc in young infants with acute watery diarrhea Am. J. Clinical Nutrition, September 1, 2005; 82(3): 605 - 610. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H. Baqui, C. L. F. Walker, K. Zaman, S. E. Arifeen, H. R. Chowdhury, M. A. Wahed, R. E. Black, and L. E. Caulfield Weekly Iron Supplementation Does Not Block Increases in Serum Zinc Due to Weekly Zinc Supplementation in Bangladeshi Infants J. Nutr., September 1, 2005; 135(9): 2187 - 2191. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C Simmonds, J. P T Higginsa, L. A Stewartb, J. F Tierneyb, M. J Clarke, and S. G Thompson Meta-analysis of individual patient data from randomized trials: a review of methods used in practice Clinical Trials, June 1, 2005; 2(3): 209 - 217. [Abstract] [PDF]
|
|
|
|
 |
|
 K. M. Hoque, V. M. Rajendran, and H. J. Binder Zinc inhibits cAMP-stimulated Cl secretion via basolateral K-channel blockade in rat ileum Am J Physiol Gastrointest Liver Physiol, May 1, 2005; 288(5): G956 - G963. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. de Romana, M. Salazar, K M. Hambidge, M. E Penny, J. M Peerson, N. F Krebs, and K. H Brown Longitudinal measurements of zinc absorption in Peruvian children consuming wheat products fortified with iron only or iron and 1 of 2 amounts of zinc Am. J. Clinical Nutrition, March 1, 2005; 81(3): 637 - 647. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Rosado, M. Diaz, K. Gonzalez, I. Griffin, S. A. Abrams, and R. Preciado The Addition of Milk or Yogurt to a Plant-Based Diet Increases Zinc Bioavailability but Does Not Affect Iron Bioavailability in Women J. Nutr., March 1, 2005; 135(3): 465 - 468. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Smuts, C. J. Lombard, A. J. S. Benade, M. A. Dhansay, J. Berger, L. T. Hop, G. Lopez de Romana, J. Untoro, E. Karyadi, J. Erhardt, et al. Efficacy of a Foodlet-Based Multiple Micronutrient Supplement for Preventing Growth Faltering, Anemia, and Micronutrient Deficiency of Infants: The Four Country IRIS Trial Pooled Data Analysis J. Nutr., March 1, 2005; 135(3): 631S - 638S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Allen and R. Shrimpton The International Research on Infant Supplementation Study: Implications for Programs and Further Research J. Nutr., March 1, 2005; 135(3): 666S - 669S. [Full Text] [PDF]
|
|
|
|
|
|
R. Shrimpton, R. Gross, I. Darnton-Hill, and M. Young Zinc deficiency: what are the most appropriate interventions? BMJ, February 12, 2005; 330(7487): 347 - 349. [Full Text] [PDF]
|
|
|
|
|
|
M. J Rahman, P. Sarker, S. K Roy, S. M Ahmad, J. Chisti, T. Azim, M. Mathan, D. Sack, J. Andersson, and R. Raqib Effects of zinc supplementation as adjunct therapy on the systemic immune responses in shigellosis Am. J. Clinical Nutrition, February 1, 2005; 81(2): 495 - 502. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Lopriore, Y. Guidoum, A. Briend, and F. Branca Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6 y Am. J. Clinical Nutrition, October 1, 2004; 80(4): 973 - 981. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. E. CAULFIELD, S. A. RICHARD, and R. E. BLACK UNDERNUTRITION AS AN UNDERLYING CAUSE OF MALARIA MORBIDITY AND MORTALITY IN CHILDREN LESS THAN FIVE YEARS OLD Am J Trop Med Hyg, August 1, 2004; 71(2_suppl): 55 - 63. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Black, S. Sazawal, R. E. Black, S. Khosla, J. Kumar, and V. Menon Cognitive and Motor Development Among Small-for-Gestational-Age Infants: Impact of Zinc Supplementation, Birth Weight, and Caregiving Practices Pediatrics, May 1, 2004; 113(5): 1297 - 1305. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Mahalanabis, M. Lahiri, D. Paul, S. Gupta, A. Gupta, M. A Wahed, and M. A Khaled Randomized, double-blind, placebo-controlled clinical trial of the efficacy of treatment with zinc or vitamin A in infants and young children with severe acute lower respiratory infection Am. J. Clinical Nutrition, March 1, 2004; 79(3): 430 - 436. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Raqib, S. K. Roy, M. J. Rahman, T. Azim, S. S. Ameer, J. Chisti, and J. Andersson Effect of zinc supplementation on immune and inflammatory responses in pediatric patients with shigellosis Am. J. Clinical Nutrition, March 1, 2004; 79(3): 444 - 450. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. H Brown Commentary: Zinc and child growth Int. J. Epidemiol., December 1, 2003; 32(6): 1103 - 1104. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Rosado Zinc and Copper: Proposed Fortification Levels and Recommended Zinc Compounds J. Nutr., September 1, 2003; 133(9): 2985S - 2989. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. de Romana, B. Lonnerdal, and K. H Brown Absorption of zinc from wheat products fortified with iron and either zinc sulfate or zinc oxide Am. J. Clinical Nutrition, August 1, 2003; 78(2): 279 - 283. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. E. Black Zinc Deficiency, Infectious Disease and Mortality in the Developing World J. Nutr., May 1, 2003; 133(5): 1485S - 1489. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hotz, N. M. Lowe, M. Araya, and K. H. Brown Assessment of the Trace Element Status of Individuals and Populations: The Example of Zinc and Copper J. Nutr., May 1, 2003; 133(5): 1563S - 1568. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Duggan, M. E Penny, P. Hibberd, A. Gil, A. Huapaya, A. Cooper, F. Coletta, C. Emenhiser, and R. E Kleinman Oligofructose-supplemented infant cereal: 2 randomized, blinded, community-based trials in Peruvian infants Am. J. Clinical Nutrition, April 1, 2003; 77(4): 937 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. B. Moore, R. K. Blanchard, and R. J. Cousins Dietary zinc modulates gene expression in murine thymus: Results from a comprehensive differential display screening PNAS, April 1, 2003; 100(7): 3883 - 3888. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. T Wieringa, M. A Dijkhuizen, C. E West, D. I Thurnham, Muhilal, and J. W. Van der Meer Redistribution of vitamin A after iron supplementation in Indonesian infants Am. J. Clinical Nutrition, March 1, 2003; 77(3): 651 - 657. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. H. Brown Diarrhea and Malnutrition J. Nutr., January 1, 2003; 133(1): 328S - 332. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H Baqui, R. E Black, S. E. Arifeen, M. Yunus, J. Chakraborty, S. Ahmed, and J P. Vaughan Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial BMJ, November 9, 2002; 325(7372): 1059 - 1059. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Berger Science commentary: What does zinc do? BMJ, November 9, 2002; 325(7372): 1062 - 1062. [Full Text] [PDF]
|
|
|
|
|
|
Effect of zinc on the treatment of Plasmodium falciparum malaria in children: a randomized controlled trial Am. J. Clinical Nutrition, October 1, 2002; 76(4): 805 - 812. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Herman, I. J Griffin, S. Suwarti, F. Ernawati, D. Permaesih, D. Pambudi, and S. A Abrams Cofortification of iron-fortified flour with zinc sulfate, but not zinc oxide, decreases iron absorption in Indonesian children Am. J. Clinical Nutrition, October 1, 2002; 76(4): 813 - 817. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Mahalanabis, A Chowdhury, S Jana, M. K Bhattacharya, M. Chakrabarti, M. A Wahed, and M. A Khaled Zinc supplementation as adjunct therapy in children with measles accompanied by pneumonia: a double-blind, randomized controlled trial Am. J. Clinical Nutrition, September 1, 2002; 76(3): 604 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Bhandari, R. Bahl, S. Taneja, T. Strand, K. Molbak, R. J. Ulvik, H. Sommerfelt, and M. K. Bhan Substantial Reduction in Severe Diarrheal Morbidity by Daily Zinc Supplementation in Young North Indian Children Pediatrics, June 1, 2002; 109(6): e86 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Duggan, J. Gannon, and W A. Walker Protective nutrients and functional foods for the gastrointestinal tract Am. J. Clinical Nutrition, May 1, 2002; 75(5): 789 - 808. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Strand, R. K. Chandyo, R. Bahl, P. R. Sharma, R. K. Adhikari, N. Bhandari, R. J. Ulvik, K. Molbak, M. K. Bhan, and H. Sommerfelt Effectiveness and Efficacy of Zinc for the Treatment of Acute Diarrhea in Young Children Pediatrics, May 1, 2002; 109(5): 898 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Dijkhuizen, F. T. Wieringa, C. E. West, S. Martuti, and Muhilal Effects of Iron and Zinc Supplementation in Indonesian Infants on Micronutrient Status and Growth J. Nutr., November 1, 2001; 131(11): 2860 - 2865. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
