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Synergistic effect of zinc and vitamin A on the biochemical indexes of vitamin A nutrition in children^1,2,3

¹ From the International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; the Department of Epidemiology & International Health, the School of Public Health, the University of Alabama at Birmingham; and the Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA.

Background: Zinc deficiency limits the bioavailability of vitamin A. Because zinc and vitamin A deficiency often coexist in malnourished children, simultaneous zinc and vitamin A supplementation may improve the vitamin A deficiency in these children.

Objective: A randomized, double-blind, placebo-controlled intervention trial was conducted to evaluate whether combining zinc and vitamin A supplementation would improve the biochemical indexes of vitamin A nutriture.

Design: Children aged 12–35 mo were randomly assigned to 1 of 4 intervention groups: 20 mg Zn/d for 14 d (Z group), 60000 retinol equivalents (200000 IU) vitamin A on day 14 (A group), zinc plus vitamin A (ZA group), or placebo syrup and placebo capsule (placebo group). Venous blood was drawn at enrollment and on day 21.

Results: Mean serum retinol concentrations were not significantly different between the A and ZA groups. Among vitamin A–deficient children, the proportion of children who remained vitamin A deficient (serum retinol <0.7 µmol/L) after supplementation was 40.6% in the Z group, 37.5% in the A group, and 47.0% in the placebo group; only 13.3% in the ZA group remained vitamin A deficient (P < 0.05 compared with the placebo group). The proportion of children whose retinol binding protein concentrations remained low was significantly lower in the ZA group than in the other groups (P < 0.05).

Conclusion: Combined zinc and vitamin A supplementation improves vitamin A nutriture in vitamin A–deficient children.

Key Words: Zinc • vitamin A • malnutrition • supplementation • retinol binding protein • retinol • children

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