Brown KH, Peerson JM, Rivera J, Allen LH. Effect of supplemental zinc on the growth and serum concentrations of prepubertal children: a meta-analysis of randomized controlled trials. Am J Clin Nutr 75, 1062-1071

Program in International Nutrition and the Department of Nutrition, University of California, Davis 95616, USA.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 07/2002; 75(6):1062-71.
Source: PubMed


Multiple studies have been carried out to assess the effect of zinc supplementation on children's growth. The results of these studies are inconsistent, and the factors responsible for these varied outcomes are unknown.
Meta-analyses of randomized controlled intervention trials were therefore completed to assess the effect of zinc supplementation on the physical growth and serum zinc concentrations of prepubertal children.
A total of 33 acceptable studies with appropriate data were identified by MEDLINE (National Library of Medicine, Bethesda, MD) searches and other methods. Weighted mean effect sizes (expressed in SD units) were calculated for changes in height, weight, weight-for-height, and serum zinc concentration by using random-effects models; factors associated with effect sizes were explored by meta-regression techniques.
Zinc supplementation produced highly significant, positive responses in height and weight increments, with effect sizes of 0.350 (95% CI: 0.189, 0.511) and 0.309 (0.178, 0.439), respectively. There was no significant effect of zinc on weight-for-height indexes [weighted mean effect size: -0.018 (-0.132, 0.097)]. Zinc supplementation caused a large increase in the children's serum zinc concentrations, with an effect size of 0.820 (0.499, 1.14). Growth responses were greater in children with low initial weight-for-age z scores and in those aged >6 mo with low initial height-for-age z scores.
Interventions to improve children's zinc nutriture should be considered in populations at risk of zinc deficiency, especially where there are elevated rates of underweight or stunting. The population mean serum zinc concentration is a useful indicator of the successful delivery and absorption of zinc supplements in children.

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    • "In agreement with our findings, a study with weanling pigs found that supplementation with zinc oxide promoted a greater daily weight gain (p < 0.001), compared with the untreated group [30]. In humans, a recent meta-analysis on preventive zinc supplementation in children highlighted significant improvements in weight gain and linear growth over time [31]. "
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    ABSTRACT: Background WHO guidelines recommend zinc supplementation as a key adjunct therapy for childhood diarrhea in developing countries, however zinc’s anti-diarrheal effects remain only partially understood. Recently, it has been recognized that low-grade inflammation may influence stunting. In this study, we examined whether oral zinc supplementation could improve weight, intestinal inflammation, and diarrhea in undernourished weanling rats. Methods Rats were undernourished using a northeastern Brazil regional diet (RBD) for two weeks, followed by oral gavage with a saturated lactose solution (30 g/kg) in the last 7 days to induce osmotic diarrhea. Animals were checked for diarrhea daily after lactose intake. Blood was drawn in order to measure serum zinc levels by atomic absorption spectroscopy. Rats were euthanized to harvest jejunal tissue for histology and cytokine profiles by ELISA. In a subset of animals, spleen samples were harvested under aseptic conditions to quantify bacterial translocation. Results Oral zinc supplementation increased serum zinc levels following lactose-induced osmotic diarrhea. In undernourished rats, zinc improved weight gain following osmotic diarrhea and significantly reduced diarrheal scores by the third day of lactose intake (p < 0.05), with improved jejunum histology (p < 0.0001). Zinc supplementation diminished bacterial translocation only in lactose-challenged undernourished rats (p = 0.03) compared with the untreated challenged controls and reduced intestinal IL-1β and TNF-α cytokines to control levels. Conclusion Altogether our findings provide novel mechanisms of zinc action in the setting of diarrhea and undernutrition and support the use of zinc to prevent the vicious cycle of malnutrition and diarrhea.
    Full-text · Article · Aug 2014 · BMC Gastroenterology
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    • "Our findings are supported by the fact that the study used a community trial design with a concurrent control group and confirmation that the supplements were successfully delivered to the participants in the intervention group, with a compliance rate, which was found to be literally perfect. Furthermore, the period of supplementation lasted 12 weeks to ensure the detection of any linear growth response, since literature indicates that periods of supplementation less than 8 weeks may be insufficient in this regard.[19] The dropout rate of participants, which was relatively small, does not seem to be a source of attrition bias, since the main reason for drop out in both groups was migration and being locally unavailable for monthly measurements, which is a common phenomenon in disadvantaged rural settings. "
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    ABSTRACT: Childhood zinc deficiency is a common problem in many developing countries where people rely mainly on plant based diets with low zinc contents. Zinc supplementation is one of strategies to combat zinc deficiency and its consequences in children. The aim of this community trial was to examine the effect of zinc supplementation on the linear growth of children 6-24 months of age and to examine the feasibility of its implementation in the context of primary health care (PHC). Rural community health centers providing maternal and child care in two areas with moderate rates of malnutrition were randomly assigned to intervention and control groups, including 393 and 445 children 6-24 months of age, respectively. Children in both groups received routine iron and multivitamin or vitamin A and D supplements through PHC services. Mothers of children in the intervention group were asked to give a single dose of 5 ml/day zinc sulfate syrup (containing 5 mg elemental zinc) to their children for 3 months while children in the control group did not receive the supplement. Anthropometric measurements were performed at baseline and on a monthly basis in both groups. We found a 0.5 cm difference in the height increment in the intervention group as compared with the control (P < 0.001). Zinc supplementation had no effect on weight increment of children. Oral zinc supplementation was found to be both practical and effective in increasing linear growth rate of children less than 2 years of age through PHC.
    Full-text · Article · Mar 2014 · International journal of preventive medicine
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    • "In a study conducted by Qin et al, 2009 in China among 2400 school children (6–9 years of age) no significant association was found between serum Zn and height for age Z scores (stunting), which was supported by our study [20]. Brown et al, 2002 in a meta-analysis study, concluded that children supplemented with Zn had greater growth increments than control groups and there was no clear pattern of response with change for weight for height Z scores with Zn supplementation [24]. "
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    ABSTRACT: Zinc deficiency is a major public health problem in many developing countries including Nepal. The present study was designed to assess the prevalence of zinc deficiency and to study the association of zinc deficiency with anthropometric and socio-demographic variables, in school children of Eastern Nepal. This cross-sectional study included total 125 school children of age group 6-12 years from Sunsari and Dhankuta districts of eastern Nepal. Plasma zinc level was estimated by Flame Atomic Absorption Spectroscopy. The Median interquartile range (IQR) values of zinc in the two districts Sunsari and Dhankuta were 5.9 (4.4, 7.9) mumol/L and 5.8 (4.3, 8.4) mumol/L respectively. A total of 55 children (87.3%) in Sunsari and 52 (83.9%) in Dhankuta had zinc deficiency, no significant difference was observed in the Median (IQR) plasma zinc levels (p = 0.9) and zinc deficiency patterns (p = 0.3) of the two districts. Significant differences were observed in the plasma zinc levels (p = 0.02) and zinc deficiency patterns (p = 0.001), of the school children having age groups 6-8 years than in 9-10 and 11-12 years of age, and zinc deficiency patterns between male and female school children (p = 0.04) respectively. The present study showed higher prevalence of zinc deficiency among school children in eastern Nepal. In our study, zinc deficiency was associated with both sex and age. The findings from the present study will help to populate data for policy implementation regarding consumption and supplementation of zinc.
    Full-text · Article · Jan 2014 · BMC Research Notes
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