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Effects of separate delivery of zinc or zinc and vitamin A on hemoglobin response, growth, and diarrhea in young Peruvian children receiving iron therapy for anemia^1,2,3

¹ From the Universidad Peruana Cayetano Heredia, Lima, Peru (KA, AMC, REV, and ILP); the A Von Humboldt Institute of Tropical Medicine, Lima, Peru (AMP); and the Institute of Tropical Medicine, Antwerp, Belgium (PWK and TFH)

Introduction: Anemia is the most prevalent nutritional deficiency in the world. Attempts to improve iron indexes are affected by deficiency of and interaction between other micronutrients.

Objective: Our goal was to assess whether zinc added to iron treatment alone or with vitamin A improves iron indexes and affects diarrheal episodes.

Design: This was a randomized, placebo-controlled, double-blind trial conducted in Peru. Anemic children aged 6–35 mo were assigned to 3 treatment groups: ferrous sulfate (FS; n = 104), ferrous sulfate and zinc sulfate (FSZn; n = 109), and ferrous sulfate, zinc sulfate, and vitamin A (FSZnA; n = 110). Vitamin A or its placebo was supplied only once; iron and zinc were provided under supervision 1 h apart 6 d/wk for 18 wk.

Results: The prevalence of anemia was 42.97%. The increase in hemoglobin in the FS group (19.5 g/L) was significantly less than that in the other 2 groups (24.0 and 23.8 g/L in the FSZn and FSZnA groups, respectively). The increase in serum ferritin in the FS group (24.5 µg/L) was significantly less than that in the other 2 groups (33.0 and 30.8 µg/L in the FSZn and FSZnA groups, respectively). The median duration of diarrhea and the mean number of stools per day was significantly higher in the FS group than in other 2 groups (P < 0.005).

Conclusion: Adding zinc to iron treatment increases hemoglobin response, improves iron indexes, and has positive effects on diarrhea. No additional effect of vitamin A was found.

Key Words: Anemia • iron • zinc • vitamin A • supplementation • acute diarrhea • children • Peru

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