The Journal of Pediatrics
Volume 135, Issue 6 , Pages 689-697 , December 1999

Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: Pooled analysis of randomized controlled trials

Received 17 February 1999 ,Revised 11 June 1999 ,Accepted 20 July 1999.

References 

  1. Gibson RS, Ferguson EL. Assessment of dietary zinc in a population. Am J Clin Nutr. 1998;68(suppl):430S–434S
  2. Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr. 1998;68(suppl):447S–463S
  3. Bahl R, Bhandari N, Hambidge KM, Bhan MK. Plasma zinc as a predictor of diarrheal and respiratory morbidity in children in an urban slum setting. Am J Clin Nutr. 1998;68(suppl):414S–417S
  4. Black RE. Therapeutic and preventive effects of zinc on serious childhood infectious diseases in developing countries. Am J Clin Nutr. 1998;68(suppl):476S–479S
  5. Ninh NX, Thissen JP, Collette L, Gerard GG, Khoi HH, Ketelslegers JM. Zinc supplementation increases growth and circulating insulin-like growth factor I (IGF-I) in growth-retarded Vietnamese children. Am J Clin Nutr. 1996;63:514–519
  6. Rosado JL, López P, Muñoz E, Martinez H, Allen LH. Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican preschoolers. Am J Clin Nutr. 1997;65:13–19
  7. Ruel MT, Rivera JA, Santizo MC, Lönnerdal B, Brown KH. Impact of zinc supplementation on morbidity from diarrhea and respiratory infections among rural Guatemalan children. Pediatrics. 1997;99:808–813
  8. Sazawal S, Black RE, Bhan MK, Jalla S, Sinha A, Bhandari N. Efficacy of zinc supplementation in reducing the incidence and prevalence of acute diarrhea - a community-based, double-blind, controlled trial. Am. J Clin Nutr. 1997;66:413–418
  9. Sazawal S, Black RE, Jalla S, Mazumdar S, Sinha A, Bhan MK. Zinc supplementation reduces the incidence of acute lower respiratory infections in infants and preschool children: a double-blind controlled trial. Pediatrics. 1998;102:1–5
  10. Subcommittee on the Tenth Edition of the RDAs of the Food and Nutrition Board. Recommended Dietary Allowances. Washington, DC: National Academy Press,; 1989;
  11. World Health Organization. Trace Elements in Human Nutrition and Health.
  12. National Center for Health Statistics . Growth curves for children birth-18 years. United States. Vital and health statistics. Series 11. Washington, DC: Govemment Printing Office; 1997; No. 165 (DHEW publication no. [PHS] 78-1650)
  13. Programme for the Control of Acute Respiratory Infections . World Health Organization, Geneva, Switzerland. Acute respiratory infections in children: Case management in small hospitals in developing countries. WHO/ARI/90.5. 1990;
  14. Eddy DM, Hasselblad V, Shachter R. In: Meta-analysis by the confidence profile method. San Diego: Academic Press, Inc:; 1992;
  15. Eddy DM, Hasselblad V, Shachter R, FAST*Pro . Software for meta-analysis by the confidence profile method. San Diego: Academic Press, Inc:; 1992;
  16. Bryk AS, Raudenbrush SW, Seltzer M, Congdon R. An introduction to HLM: Computer program and user’s guide. 2nd ed. Chicago: University of Chicago: Department of Education; 1989;
  17. Dickersin K, Berlin JA. Meta-analysis: State-of-the-science. Epidemiol Rev. 1992;14:154–176
  18. Shankar AH, Genton B, Tamja S, Arnold S, Wu L, Baisor M, et al.  Zinc supplementation can reduce malaria-related morbidity in preschool children [abstract]. Am J Trop Med Hyg. 1997;57:A434
  19. Penny ME, Peerson JM, Marin RM, Duran A, Lanata CF, Lönnerdal B, et al.  Randomized, community-based trial of the effect of zinc supplementation, with and without other micronutrients, on the duration of persistent childhood diarrhea in Lima. Peru. J Pediatr. 1999;135:208–217
  20. Meeks Gardner JM, Witter MM, Ramdath DD. Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children. Eur J Clin Nutr. 1998;52:34–39
  21. Roy SK, Tornkins AM, Haider R, Akramuzzaman SM, Behrens RH, Mahalanabis D. Impact of zinc supplementation on subsequent growth and morbidity in children presenting with persistent diarrhoea syndrome (PDS) in Bangladesh [abstract]. In: Second Commonwealth Conference on Diarrhea and Malnutrition, New Delhi. 1994;
  22. Bhutta ZA, Nizami SQ, Niazi SK, Issani A. Zinc supplementation in persistent diarrhea in Pakistan. Pediatrics. 1999;103:e42
  23. Roy SK, Tomkins AM, Haider R, Akramuzzaman SM, Behrens R. Impact of zinc supplementation on subsequent growth and morbidity in Bangladeshi children with acute diarrhoea [abstract]. In: Annual Scientific Conference, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka. 1991;
  24. Sazawal S, Black RE, Bhan MK, Bhandari N, Jalla S, Sinha A, et al.  Zinc supplementation reduces the incidence of persistent diarrhea and dysentery among low socioeconomic children in India. J Nutr. 1996;1265:443–450
  25. Sachdev HPS, Mittal NK, Mittal SK, Yadav HS. A controlled trial on utility of oral zinc supplementation in acute dehydrating diarrhea in infants. J Pediatr Gastroenterol Nutr. 1988;7:877–881
  26. Sazawal S, Black RE, Ghan MK, Bhandari N, Sinha A, Jalla S. Zinc supplementation in young children with acute diarrhea in India. N Engl J Med. 1995;333:839–844
  27. Roy SK, Tomkins AM, Akramuzzaman SM, Behrens RH, Haider R, Mahalanabis D, et al.  Randomised controlled trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhoea. Arch Dis Child. 1997;77:196–200
  28. Hidayat A, Achadi A, Sunoto , Soedarmo SP. The effect of zinc supplementation in children under three years of age with acute diarrhea in Indonesia [abstract]. Asian Conference on Diarrhoeal Diseases. 1997;
  29. Sachdev HPS, Mittal NK, Yadav HS. Oral zinc suplplementation in persistent diarrhoea in infants. Ann Trop Paediatr. 1990;10:63–69
  30. Roy SK, Tomkins AM, Mahalanabis D, Akramuzzaman SM, Haider R, Behrens RH, et al. Persistent diarrhoea: Impact of zinc supplementation in malnourished Bangladeshi children. Acta Paediatrica (in press).
  31. Khatun UHF. Impact of zinc and vitamin A supplementation in malnourished hospitalized children suffering from persistent diarrhoea. Thesis submitted to the University of Dhaka for the degree of Doctor of Philosophy in the Institute of Nutrition & Food Science. July 1998;
  32. Esrey SA, Feachem RG, Hughes JM. Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities. Bull World Health Organ. 1985;63:757–772
  33. Beaton GH, Martorell R, Aronson KJ, Edmonston B, McCabe G, Ross AC, et al. Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries. ACC/SCN State-of-the-Art Series. Nutrition Policy Discussion Paper No. 13, World Health Organization, Geneva.
  34. Victora CG, Kirkwood BR, Ashworth A, Black RE, Rogers S, Sazawal S, et al.  Potential interventions for the prevention of childhood pneumonia in developing countries: improving nutrition. Am J Clin Nutr. 1999;70:309–320
  35. Brown KH. Effect of infections on plasma zinc concentration and implications for zinc status assessment in low-income countries. Am J Clin Nutr. 1998;68(suppl):425S–429S
  36. Sanstead HH. Is zinc deficiency a public health problem?. Nutrition. 1995;11:87–92
  37. Lira PLC, Ashworth A, Morris SS. Effect of zinc supplementation on the morbidity, immune function, and growth of low-birth-weight, fall-term infants in northeast. Am J Clin Nutr. 1998;68(suppl):418S–424S
  38. Sazawal S, Black RE, Jalla S, Mazumdar S, Sinha A, Bhan MK. Effect of zinc supplementation on cell-mediated immunity and lymphocyte subsets in preschool children. Indian Pediatr. 1997;34:589–597
  39. Sempértegui F, Estrella B, Correa E, Aguirre L, Saa B, Torres M, et al.  Effects of short-term zinc supplementation on cellular immunity, respiratory symptoms, and growth of malnourished Equadorian children. Eur J Clin Nutr. 1996;50:42–46
  40. Gibson RS, Ferguson EL, Lehrfeld J. Complementary foods for infant feed in developing countries: their nutrient adequacy and improvement. Eur J Clin Nutr. 1998;52:764–770
  41. Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr. 1998;68(suppl):447S–463S
  42. Duchateau J, Delespesse G, Vereecke P. Influence of oral zinc supplementation on the lymphocyte response to mitogens of normal subjects. Am J Clin Nutr. 1981;34:88–93
  43. Stewart LA, Parmar MKB. Meta-analysis of the literature or of individual patient data: is there a difference?. Lancet. 1993;2141:417–422
  44. Prasad AS. Discovery of human zinc deficiency and studies in an experimental human model. Am J Clin Nutr. 1991;543:403–412
  45. Murphy SP, Beaton GH, Calloway DH. Estimated mineral intakes of toddlers: predicted prevalence of inadequacy in village populations in Egypt, Kenya, and Mexico. Am J Clin Nutr. 1992;56:565–572
  46. Rahmanifar A, Kirksey A, McCabe GP, Galal OM, Harrison GG, Jerome NW. Respiratory tract and diarrheal infections of breast-fed infants from birth to 6 months of age in household contexts of an Egyptian village. Eur J Clin Nutr. 1996;50:655–662
  47. Friis H, Ndhlovu P, Mduluza T, Kaondera K, Sandström B, Michaelsen KF, et al.  The impact of zinc supplementation on growth and body composition: A randomized, controlled trial among rural Zimbabwean schoolchildren. Eur J Clin Nutr. 1997;51:38–45
  48. Sazawal S, Black RE, Menon VP, Dhingra U, Dhingra P, Mazumder S, et al.  Effect of zinc and mineral supplementation in small for gestational age infants on growth and mortality. FASEB J. 1999;A309:7
  49. Saldamli I, Köksel H, Özboy Ö, Özalp I, Kilic I. Zinc-supplemented bread and its utilization in zinc deficiency. Cereal Chemistry 199,5;73:424-6.
  50. Gibson RS, Yeudall F, Drost N, Mtitimuni B, Cullinan T. Dietary interventions to prevent zinc deficiency. Am J Clin Nutr. 1998;68(suppl):484S–487S
  51. Ruel MT, Bouis HE. Plant breeding: a long-term strategy for the control of zinc deficiency in vulnerable populations. Am J Clin Nutr. 1998;68(suppl):488S–494S
  52. Allen LS. Zinc and micronutrient supplements for children. Am J Clin Nutr. 1998;68(suppl):495S; SS

☆ *Members of the group are listed in alphabetical order.

☆☆ Supported by the Johns Hopkins Family Health and Child Survival Cooperative Agreement with the US Agency for International Development and the World Health Organization, Division of Child Health and Development. R. Black drafted the manuscript while in residence at the Rockefeller Foundation Bellagio Study and Conference Center.

★ Reprint requests: Robert Black, MD, MPH, Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD 21205.

★★ 0022-3476/99/$8.00 + 0  9/21/101639

PII: S0022-3476(99)70086-7

The Journal of Pediatrics
Volume 135, Issue 6 , Pages 689-697 , December 1999

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