A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein-energy malnutrition in Lesotho. II: Special investigations. Regression of Nonalcoholic Fatty Liver Disease with Zinc and Selenium Co-supplementation after Disease Progression in Rats Effect of zinc supplementation on body mass index and serum levels of zinc and leptin in pediatric hemodialysis patients Effect of vitamin D supplementation on inflammation: protocol for a systematic review Zinc supplementation therapy improves the outcome of patients with chronic hepatitis C Nucleoside Analogue Can Improve the Long-Term Prognosis of Patients with Hepatitis B Virus Infection-Associated Acute on Chronic Liver Failure Effect of zinc supplementation on viral response in patients with chronic hepatitis C and Beta thalassemia major, a pilot study. Zinc and Selenium Co-supplementation Reduces Some Lipid Peroxidation and Angiogenesis Markers in a Rat Model of NAFLD-Fed High Fat Diet Redistribution of vitamin A after iron supplementation in Indonesian infants. Zinc distribution in blood components, inflammatory status, and clinical indexes of disease activity during zinc supplementation in inflammatory rheumatic diseases. Global and regional child mortality and burden of disease attributable to zinc deficiency Zinc supplementation in alcoholic cirrhosis. A double-blind clinical trial. Management of chronic pressure ulcers: an evidence-based analysis. Safety and efficacy of zinc supplementation for children with HIV-1 infection in South Africa: a randomised double-blind placebo-controlled trial Inflammation markers predict zinc transporter gene expression in women with type 2 diabetes mellitus. Zinc supplementation prevents the increase of transaminase in chronic hepatitis C patients during combination therapy with pegylated interferon alpha-2b and ribavirin. Effect of zinc supplementation on growth and body composition in children with sickle cell disease. Effect of zinc supplementation on incidence of infections and hospital admissions in sickle cell disease (SCD) [Alcohol-induced toxic hepatitis--a "free radical" associated disease. Lowering fatality by adjuvant antioxidant therapy]. Preoperative total cholesterol predicts postoperative outcomes after partial hepatectomy in patients with chronic hepatitis B- or C-related hepatocellular carcinoma. Copper enzyme activities in cystic fibrosis before and after copper supplementation plus or minus zinc. Effect of zinc supplementation on mortality in children aged 1–48 months: a community-based randomised placebo-controlled trial Randomized, controlled clinical trial of zinc supplementation to prevent immunological failure in HIV-infected adults.
Protein-energy malnutrition ( PEM ) remains one of the common causes of morbidity and mortality among children throughout the world . The supplementation of 10 mg elemental zinc , as zinc sulphate , was evaluated in the management of PEM in a r and omized , controlled , double-blind clinical trial in 300 children , aged 6 - 60 months ( zinc , n = 150 ; control , n = 150 ) admitted to the Queen Elizabeth II Hospital , Maseru , Lesotho .  Supplementation and follow-up were done for 3 months post-discharge from the hospital . Both the supplemented and the control groups presented with biochemically determined zinc deficiency on presentation . Despite supplementation the treated group only began to show evidence of biochemical increase in serum zinc at 60 days post-discharge from hospital . This may represent the period of replacement of the total body zinc . Zinc deficiency was more severe in those children in the control group that died after admission to hospital than those that survived , suggesting that low serum levels in children with PEM are associated with a poor prognosis . Zinc did not emerge as a predicator of poor prognosis in the supplemented group as very few children died in this group . The supplemented group also made significant gains as far as albumin levels were concerned , which probably reflects rehabilitation of their malnutrition . The associated improvement in haematological parameters has not been described before and may be secondary to the decreased burden of disease in the supplemented group . These findings suggest that not only were significant benefits of zinc supplementation shown for morbidity in mortality of children in Lesotho with PEM , but these trends were also demonstrated on biochemical profiles Background : Studies have shown that zinc and selenium deficiency is common in nonalcoholic fatty liver disease ( NAFLD ) . However , the effects of zinc and selenium co-supplementation before and /or after disease progression on NAFLD are not clear enough . The aim of this study was to compare the effects of zinc and selenium co-supplementation before and /or after disease progression on NAFLD prognosis . Material s and Methods : Forty male Sprague – Dawley rats ( 197±4 g ) were r and omly assigned to 4 dietary groups : normal-fat diet ( NFD ; receiving 9 % of calories as fat ) , high-fat diet ( HFD ; receiving 82 % of calories as fat ) , supplementation before disease progression ( S+HFD ) , and supplementation after disease progression ( HFD+S ) . The diets were implemented over a 20-week period in all the groups . Biochemical and histologic parameters were compared between the 4 groups , and between-group comparisons were also carried out . Results : There were significant differences in the average food dietary intake ( P<0.001 ) , weight ( P<0.001 ) , fasting blood sugar ( P=0.005 ) , triglyceride ( P<0.001 ) , total cholesterol ( P<0.001 ) , low-density lipoprotein cholesterol ( P=0.002 ) , high-density lipoprotein cholesterol ( P=0.001 ) , alanine aminotransferase ( P<0.001 ) , and aspartate aminotransferase ( P<0.001 ) between the 4 dietary groups . Serum triglyceride and total cholesterol were significantly lower in the HFD+S Group than in the S+HFD Group ( P<0.001 and P=0.003 , respectively ) . Fat accumulation was significantly reduced in the HFD+S Group ( P<0.001 ) . Conclusion : Zinc and selenium co-supplementation after disease progression improved biochemical and histologic parameters in an experimental model of NAFLD Introduction Zinc is an essential trace element for human nutrition , and its deficiency is associated with anorexia , poor food efficiency , growth retardation , and impaired neurological and immune systems . The zinc-deficiency rate is particularly high in many disease states , such as with end-stage renal disease patients undertaking hemodialysis . The aim of this study was to determine the effect of zinc supplementation on body mass index ( BMI ) and serum levels of zinc and leptin in pediatric hemodialysis patients . Patients and methods This was a prospect i ve clinical trial study in which 60 hemodialysis patients were r and omly divided into two groups : group I received 50–100 mg zinc sulfate ( equivalent to 11–22 mg elemental zinc ) according to age , sex , and nutritional status of the child ; and group II received placebo ( cornstarch ) twice daily for 90 days . Anthropometric measurements were taken , and serum zinc and leptin levels were determined by colorimetric test with 5-Br-3′-phosphoadenosine-5′-phosphosulfate and enzyme-linked immunosorbent assay , respectively , at days 0 and 90 of the study . Results Zinc supplementation result ed in a significant increase in mean serum zinc level and BMI . Serum leptin decreased significantly after supplementation in children under hemodialysis . A significant negative correlation was observed between serum zinc and leptin levels as a result of zinc supplementation . Conclusion There was an increase in serum zinc level and BMI and decreased serum leptin  after zinc supplementation in children under hemodialysis Introduction The extraskeletal role of vitamin D is being increasingly recognised . This has important clinical implication s , as vitamin D deficiency has reached epidemic proportions worldwide . Vitamin D has proposed anti-inflammatory properties , yet the role of vitamin D supplementation in reducing inflammation remains largely unknown . The purpose of this review is to investigate the impact of vitamin D supplementation on inflammation , and to identify relevant knowledge gaps in the field . Methods and analysis Medline , CINAHL , EMBASE and All EBM will be systematic ally search ed for r and omised controlled trials ( RCTs ) and systematic review s of RCTs , comparing vitamin D supplementation with placebo , usual care or other pharmacological or non-pharmacological interventions . One review er will assess articles for eligibility according to prespecified selection criteria , after which 2 independent review ers will perform data extraction and quality appraisal . Meta-analyses will be conducted where appropriate . Ethics and dissemination Formal ethical approval is not required as no primary data is collected . This systematic review will identify potential clinical implication s of vitamin D deficiency and supplementation , and will be disseminated through a peer- review ed publication and at conference meetings , to inform future research on the efficacy of vitamin D supplementation for inflammation and inflammatory diseases . PROSPERO registration number CRD42016037104 We administered zinc supplementation therapy over three years to patients with chronic hepatitis C and reported and that the aspartate aminotransferase ( AST ) and alanine aminotaransferase ( ALT ) levels decreased , and platelet counts increased , significantly in the group with increased serum zinc concentrations . We are continuing this treatment to clarify the long-term consequences and report here the changes in serum zinc concentrations over seven years and compare the cumulative incidence of hepatocellular carcinoma ( HCC ) . We administered polaprezinc to 32 patients , r and omly selected for zinc therapy ( treatment group ) , while another 30 formed the control group . We measured the serum zinc and albumin concentrations and conducted a prospect i ve study to determine long-term outcomes . The changes and rates of change of serum zinc concentrations after seven years were 76.7 ± 18.2 µg/dl and + 0.302 ± 0.30 % in the treatment group and 56.7 ± 12.4 µg/dl and + 0.033 ± 0.21 % in the control group and had increased significantly ( p = 0.0002 , p = 0.0036 ) . Progression of liver disease seemed to vary , depending on serum albumin concentrations . In the group with baseline serum albumin concentrations of 4.0 g/dl or more , the change and rate of change of serum zinc concentrations increased significantly , and the cumulative incidence of HCC tended to decrease , in the treated group . According to multivariate analysis , the factors that contribute to a reduction in the incidence of HCC are  zinc therapy ( risk ratio : 0.113 , 95 % CI : 0.015–0.870 , p = 0.0362 ) , and platelet counts ( 0.766 , 0.594–0.989 , 0.0409 ) . Zinc supplementation therapy seems to improve liver pathology and reduce the incidence of HCC Background The prognosis of patients with hepatitis B virus (HBV)-associated acute on chronic liver failure ( ACLF ) is extremely poor . Aim This study was design ed to evaluate the efficacy and safety of nucleoside analogue treatment of patients with HBV-associated ACLF . Methods We used a retrospective review of eligible patients from April 2006 to December 2008 . Eligible subjects received 0.5 mg entecavir daily until October 2009 ( group A ) , 100 mg lamivudine daily until October 2009 ( group B ) , or no nucleoside analogue ( group C ) . The primary endpoints were three-month survival and the rate of recurrence of HBV-associated ACLF . The secondary endpoints were HBV DNA levels , liver function , the model of end-stage liver disease ( MELD ) score , and adverse events . Results A total of 104 consecutive patients were recruited , and 33 , 34 , and 37 patients were r and omly allocated to groups A , B , and C , respectively . Although no significant difference in three-month survival was observed , levels of HBV DNA and rates of recurrence of HBV-associated ACLF were lower . Liver function and MELD score were not significantly improved despite significantly reduced HBV DNA levels . Conclusions These data indicated that nucleoside analogue treatment did not improve the short-term prognosis of patients with HBV-associated ACLF although it was efficacious and safe in the management of HBV DNA levels . Intriguingly and importantly , continuous nucleoside analogue treatment can significantly reduce the rate of recurrence , which might be indicative of the further benefit of long-term survival INTRODUCTION Zinc deficiency has been reported in patients with both hepatitis C and beta thalassemia major .  Zinc supplementation in addition to antiviral therapy of chronic hepatitis C has been accompanied by some success in patients with chronic hepatitis C. OBJECTIVE The aim of the present pilot study is to determine the effect of 30 mg elemental zinc on biochemical and virological response in a population of patients with chronic hepatitis C with beta thalassemia major . MATERIAL S AND METHODS A prospect i ve , double blind , placebo controlled trial included 40 patients being treated with Pegylated interferon Alfa ( Peg IFN-α ) and ribavirin .  Biochemical and virological parameters and plasma zinc levels were determined before starting treatment . Patients were r and omly selected to receive either zinc or a placebo in addition to Peg IFN-α and ribavirin for a period of one year . AST , ALT , sustained viral response ( SVR ) , and zinc levels were measured after treatment . Of the original 40 eligible patients , eight withdrawn from the study and 32 patients completed the study ; 16 in the zinc group and 16 in the placebo group . Analysis of the data shows that there is no difference between the two groups in AST , ALT , SVR or zinc level following one year of treatment ( p=0.224 , p=0.616 , p=0.670 , p=0.999 , respectively ) . CONCLUSION The results of this study indicate that using 30 mg/day elemental zinc did not significantly improve the outcome of treatment in thalassemia patients with chronic hepatitis C. In future studies , we recommend trying higher doses zinc in patients with hepatitis C who had beta thalassemia major Studies have shown that non-alcoholic fatty liver disease ( NAFLD ) patients are more prone to cardiovascular disease ( CVD ) . Zinc and selenium deficiency are common in NAFLD . But the effects of zinc and selenium co-supplementation before and /or after disease progression on CVD markers are not clear in NAFLD patients . This study aim ed to compare the effects of zinc and selenium co-supplementation before and /or after disease progression on some of the CVD markers in an experimental model of NAFLD . Forty male Sprague Dawley rats ( 197 ± 4 g ) were r and omly assigned into four dietary groups : control group ( C ; received 9 % of calorie as fat ) , model group ( M ; received 82 % of calorie as fat ) , and supplementation before ( BS ) or after ( AS ) disease progression . Animals were fed diets for 20 weeks in all groups . Fasting plasma glucose ( FPG ) , insulin , HOMA-IR , ALT , AST , lipid profile , malondialdehyde ( MDA ) and vascular endothelial growth factor ( VEGF ) levels were measured as CVD indices . Serum ALT , AST , FPG , insulin , MDA , VEGF and HOMA-IR were significantly higher in the M than C group . Co-supplementation reduced serum ALT and AST levels in the BS and AS groups compared with the M group . FPG , insulin , HOMA-IR , VEGF , MDA , LDL/HDL-c and TC/HDL-c ratio were significantly reduced in the AS compared with the M group . TG/HDL-c ratio was significantly reduced in the BS and AS compared with the M group . Serum MDA , VEGF , Insulin and HOMA-IR were significantly lowered in the AS than BS group ( p < 0.05 ) . Zinc and selenium co-supplementation after NAFLD progression reduced CVD risk indices in an experimental model BACKGROUND Deficiencies of iron and vitamin A are prevalent worldwide . Single-micronutrient supplementation is widely used to combat these deficiencies . However , micronutrient deficiencies often occur concurrently , and there are many interactions between micronutrients . OBJECTIVE This study investigated interactions among 3 important micronutrients -- iron , vitamin A , and zinc -- when they are given as supplements . DESIGN In a r and omized , double-blind , placebo-controlled supplementation trial , 387 Indonesian infants aged 4 mo were supplemented 5 d/wk for 6 mo with 10 mg Fe , 10 mg Zn , 2.4 mg beta-carotene , 10 mg each of Fe and Zn , 10 mg Zn + 2.4 mg beta-carotene , or placebo . Complete data on micronutrient status , including hemoglobin , ferritin , retinol , zinc , and the modified relative dose response ( a measure of liver retinol stores ) , were available from 256 infants at the end of the study . RESULTS Iron-supplemented infants had significantly lower plasma retinol concentrations and a significantly higher prevalence of vitamin A deficiency , as defined by a plasma retinol concentration < 0.70 micromol/L , than did the non-supplemented infants . In contrast , the modified relative dose response of the iron-supplemented infants indicated greater liver stores of vitamin A.  Iron supplementation improved iron status , and zinc supplementation improved zinc status , but beta-carotene supplementation did not significantly improve vitamin A status . CONCLUSIONS In this study , iron supplementation in infants with marginal vitamin A status led to lower plasma vitamin A concentrations and simultaneously to greater vitamin A liver stores . This implies a redistribution of retinol after iron supplementation , which might induce vitamin A deficiency . Therefore , iron supplementation in infants should be accompanied by measures to improve vitamin A status The effects of zinc supplementation on zinc status and on clinical and biological indicators of inflammation were investigated in 18 patients with chronic inflammatory rheumatic diseases and in 9 healthy control subjects . Patients with mild and recent onset disease were assigned to a 60-d trial to receive either 45 mg Zn ( as gluconate)/d or a placebo , while control subjects received the zinc supplement .  Baseline mean plasma zinc of the patients was low whereas mononuclear cell zinc content was elevated , suggesting a redistribution of the element related to the inflammatory process rather than to a zinc-deficient state . Zinc supplementation increased plasma zinc to a similar extent in patients and in control subjects , which suggested no impairment of zinc intestinal absorption as a result of the inflammatory process . On the contrary , erythrocyte and leukocyte zinc concentrations were not modified in the two groups examined . No beneficial effect of zinc treatment could be demonstrated on either clinical or inflammation indexes Background / Objectives : Zinc is an essential micronutrient and deficiency can lead to an increased risk for infectious diseases and growth retardation among children under 5 years of age . We aim ed to estimate disease-specific and all-cause mortality attributable to zinc deficiency . Subject/ Methods : We estimated the prevalence of zinc deficiency in Latin America , Africa and Asia , where based on zinc availability in the diet and childhood stunting rates , zinc deficiency is widespread . The relative risks of death among zinc-deficient children for diarrhea , malaria and pneumonia were estimated from r and omized controlled trials . We used the comparative risk assessment methods to calculate deaths and burden of disease ( measured in disability-adjusted life years , DALYs ) from each of these three diseases attributable to zinc deficiency in these regions . Results : Zinc deficiency was responsible for 453 207 deaths ( 4.4 % of childhood deaths ) , and 1.2 % of the burden of disease ( 3.8 % among children between 6 months and 5 years ) in these three regions in 2004 . Of these deaths , 260 502 were in Africa , 182 546 in Asia and 10 159 in Latin America . Zinc deficiency accounted for 14.4 % of diarrhea deaths , 10.4 % of malaria deaths and 6.7 % of pneumonia deaths among children between 6 months and 5 years of age . Conclusions : Zinc deficiency contributes to substantial morbidity and mortality , especially from diarrhea .  Zinc supplementation provided as an adjunct treatment for diarrhea may be the best way to target children most at risk of deficiency A double-blind clinical trial with zinc sulfate , 0.2 g three times daily , and a placebo was performed in 30 patients with biopsy-proven alcoholic liver cirrhosis . The disease was in a stable phase , and none of the patients showed evidence of a decompensated liver function . Parameters of liver function , taste acuity , dark adaptation and of zinc and vitamin A metabolism were followed for six weeks . In the zinc-treated group of 16 patients , serum zinc rose from a normal mean value of 13.3 to 17.4 mumol/l , whereas the mean serum vitamin A level remained practically unaltered within the normal range , 1.89 at the entry and 1.83 mumol/l at the end of the study . Plasma prothrombin and serum alkaline phosphatase levels of the zinc group increased and serum bilirubin and serum carotene decreased significantly . The dark adaptation did not change , but the taste function was significantly improved during zinc treatment . The results indicate that zinc supplementation causes alleviation of certain abnormalities of cirrhotics , which deserves further attention UNLABELLED In April 2008 , the Medical Advisory Secretariat began an evidence -based review of the literature concerning pressure ulcers . Please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series . PRESSURE ULCER PREVENTION : an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario : projections of the Ontario Pressure Ulcer Model ( field evaluation)MANAGEMENT OF CHRONIC PRESSURE ULCERS : an evidence -based analysis OBJECTIVE The Medical Advisory Secretariat ( MAS ) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions : Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with st and ard care , a placebo , or other similar interventions ? Within each category of intervention , which one is most effective in promoting the healing of existing pressure ulcers ? BACKGROUND A pressure ulcer is a localized injury to the skin and /or underlying tissue usually over a bony prominence , as a result of pressure , or pressure in conjunction with shear and /or friction . Many areas of the body , especially the sacrum and the heel , are prone to the development of pressure ulcers . People with impaired mobility ( e.g. , stroke or spinal cord injury patients ) are most vulnerable to pressure ulcers . Other factors that predispose people to pressure ulcer formation are poor nutrition , poor sensation , urinary and fecal incontinence , and poor overall physical and mental health . The prevalence of  pressure ulcers  in Ontario has been estimated to range from a median of 22.1 % in community setting s to a median of 29.9 % in nonacute care facilities . Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400 % , to increase the frequency and duration of hospitalization , and to decrease the quality of life of affected patients . The cost of treating pressure ulcers has been estimated at approximately $ 9,000 ( Cdn ) per patient per month in the community setting . Considering the high prevalence of pressure ulcers in the Ontario health care system , the total cost of treating pressure ulcers is substantial . TECHNOLOGY Wounds normally heal in 3 phases ( inflammatory phase , a proliferative phase of new tissue and matrix formation , and a remodelling phase ) . However , pressure ulcers often fail to progress past the inflammatory stage . Current practice for treating pressure ulcers includes treating the underlying causes , debridement to remove necrotic tissues and contaminated tissues , dressings to provide a moist wound environment and to manage exu date s , devices and frequent turning of patients to provide pressure relief , topical applications of biologic agents , and nutritional support to correct nutritional deficiencies . A variety of adjunctive physical therapies are also in use . METHOD Health technology assessment data bases and medical data bases were search ed from 1996 ( Medline ) , 1980 ( EMBASE ) , and 1982 ( CINAHL ) systematic ally up to March 2008 to identify r and omized controlled trials ( RCTs ) on the following treatments of pressure ulcers :  cleansing , debridement , dressings , biological therapies , pressure-relieving devices , physical therapies , nutritional therapies , and multidisciplinary wound care teams . Full literature search strategies are reported in appendix 1 . English- language studies in previous systematic review s and studies published since the last systematic review were included if they had more than 10 subjects , were r and omized , and provided objective outcome measures on the healing of pressure ulcers . In the absence of RCTs , studies of the highest level of evidence available were included . Studies on wounds other than pressure ulcers and on surgical treatment of pressure ulcers were excluded . A total of 18 systematic review s , 104 RCTs , and 4 observational studies were included in this review . Data were extracted from studies using st and ardized forms . The quality of individual studies was assessed based on adequacy of r and omization , concealment of treatment allocation , comparability of groups , blinded assessment , and intention-to-treat analysis . Meta- analysis to estimate the relative risk ( RR ) or weighted mean difference ( WMD ) for measures of healing was performed when appropriate . A descriptive synthesis was provided where pooled analysis was not appropriate or not feasible . The quality of the overall evidence on each intervention was assessed using the grading of recommendations assessment , development , and evaluation ( GRADE ) criteria . FINDINGS Findings from the analysis of the included studies are summarized below : CLEANSING : There is no good trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers . DEBRIDEMENT : There was no evidence that debridement using collagenase , dextranomer , cadexomer iodine , or maggots significantly improved complete healing compared with placebo . There were no statistically significant differences between enzymatic or mechanical debridement agents with the following exceptions : Papain urea result ed in better debridement than collagenase . Calcium alginate result ed in a greater reduction in ulcer size compared to dextranomer . Adding streptokinase/streptodornase to hydrogel result ed in faster debridement . Maggot debridement result ed in more complete debridement than conventional treatment . There is limited evidence on the healing effects of debridement devices . DRESSINGS : Hydrocolloid dressing was associated with almost three-times more complete healing compared with saline gauze . There is evidence that hydrogel and hydropolymer may be associated with 50 % to 70 % more complete healing of pressure ulcers than hydrocolloid dressing . No statistically significant differences in complete healing were detected among other modern dressings . There is evidence that polyurethane foam dressings and hydrocellular dressings are more absorbent and easier to remove than hydrocolloid dressings in ulcers with moderate to high exu date s . In deeper ulcers ( stage III and IV ) , the use of alginate with hydrocolloid result ed in significantly greater reduction in the size of the ulcers compared to hydrocolloid alone . Studies on sustained silver-releasing dressing demonstrated a tendency for reducing the risk of infection and promoting faster healing , but the sample sizes were too small for statistical analysis or for drawing conclusions . BIOLOGICAL THERAPIES : The efficacy of platelet-derived growth factors ( PDGFs ) , fibroblast growth factor , and granulocyte-macrophage colony stimulating factor in improving complete healing of chronic pressure ulcers has not been established . Presently only Regranex , a recombinant PDGF , has been approved by Health Canada and only for treatment of diabetic ulcers in the lower extremities . A March 2008 US Food and Drug Administration ( FDA ) communication reported increased deaths from cancers in people given three or more prescriptions for Regranex . Limited low- quality evidence on skin matrix and engineered skin equivalent suggests a potential role for these products in healing refractory  advanced chronic pressure ulcers , but the evidence is insufficient to draw a conclusion . ADJUNCTIVE PHYSICAL THERAPY : There is evidence that electrical stimulation may result in a significantly greater reduction in the surface area and more complete healing of stage II to IV ulcers compared with sham therapy . No conclusion on the efficacy of electrotherapy can be drawn because of significant statistical heterogeneity , small sample sizes , and method ological flaws . The efficacy of other adjunctive physical therapies [ electromagnetic therapy , low-level laser ( LLL ) therapy , ultrasound therapy , ultraviolet light therapy , and negative pressure therapy ] in improving complete closure of pressure ulcers has not been established . NUTRITION THERAPY : Supplementation with 15 grams of hydrolyzed protein 3 times daily did not affect complete healing but result ed in a 2-fold improvement in Pressure Ulcer Scale for Healing ( PUSH ) score compared with placebo . Supplementation with 200 mg of zinc three times per day did not have any significant impact on the healing of pressure ulcers compared with a placebo . Supplementation of 500 mg ascorbic acid twice daily was associated with a significantly greater decrease in the size of the ulcer compared with a placebo but did not have any significant impact on healing when compared with supplementation of 10 mg ascorbic acid three times daily . A very high protein tube feeding ( 25 % of energy as protein ) result ed in a greater reduction in ulcer area in institutionalized tube-fed patients compared with a high protein tube feeding ( 16 % of energy as protein).Multinutrient supplements that contain zinc , arginine , and vitamin C were associated with a greater reduction in the area of the ulcers compared with st and ard hospital diet or to a st and ard supplement without zinc , arginine , or vitamin C.Firm conclusions can not be drawn because of method ological flaws and small sample sizes . MULTIDISCIPLINARY WOUND CARE TEAMS : The only RCT suggests that multidisciplinary wound care teams may significantly improve healing in the acute care setting in 8 weeks and may significantly shorten the length of hospitalization . However , since only an abstract is available , study biases can not be assessed and no conclusions can be drawn on the quality of this evidence BACKGROUND Zinc deficiency is associated with impaired immune function and an increased risk of infection . Supplementation can decrease the incidence of diarrhoea and pneumonia in children in re source -poor countries . However , in children with HIV-1 infection , the safety of zinc supplementation is uncertain . We aim ed to assess the role of zinc in HIV-1 replication before mass zinc supplementation is recommended in regions of high HIV-1 prevalence . METHODS We did a r and omised double-blind placebo-controlled equivalence trial of zinc supplementation at Grey 's Hospital in Pietermaritzburg , South Africa . 96 children with HIV-1 infection were r and omly assigned to receive 10 mg of elemental zinc as sulphate or placebo daily for 6 months . Baseline measurements of plasma HIV-1 viral load and the percentage of CD4 + T lymphocytes were established at two study visits before r and omisation , and measurements were repeated 3 , 6 , and 9 months after the start of supplementation . The primary outcome measure was plasma HIV-1 viral load . Analysis was per protocol . FINDINGS The mean log(10 ) HIV-1 viral load was 5.4 ( SD 0.61 ) for the placebo group and 5.4 ( SD 0.66 ) for the zinc-supplemented group 6 months after supplementation began ( difference 0.0002 , 95 % CI -0.27 to 0.27 ) . 3 months after supplementation ended , the corresponding values were 5.5 ( SD 0.77 ) and 5.4 ( SD 0.61 ) , a difference of 0.05 ( -0.24 to 0.35 ) . The mean percentage of CD4 + T lymphocytes and median haemoglobin concentrations were also similar between the two groups after zinc supplementation . Two deaths occurred in the zinc supplementation group and seven in the placebo group ( p=0.1 ) . Children given zinc supplementation were less likely to get watery diarrhoea than those given placebo .  Watery diarrhoea was diagnosed at 30 ( 7.4 % ) of 407 clinic visits in the zinc-supplemented group versus 65 ( 14.5 % ) of 447 visits in the placebo group ( p=0.001 ) . INTERPRETATION Zinc supplementation of HIV-1-infected children does not result in an increase in plasma HIV-1 viral load and could reduce morbidity caused by diarrhoea . RELEVANCE TO PRACTICE Programmes to enhance zinc intake in deficient population s with a high prevalence of HIV-1 infection can be implemented without concern for adverse effects on HIV-1 replication . In view of the reductions in diarrhoea and pneumonia morbidity , zinc supplementation should be used as adjunct therapy for children with HIV-1 infection The pathology of type 2 diabetes mellitus ( DM ) often is associated with underlying states of conditioned zinc deficiency and chronic inflammation . Zinc and omega-3 polyunsaturated fatty acids each exhibit anti-inflammatory effects and may be of therapeutic benefit in the disease . The present r and omized , double-blind , placebo-controlled , 12-week trial was design ed to investigate the effects of zinc ( 40 mg/day ) and α-linolenic acid ( ALA ; 2 g/day flaxseed oil ) supplementation on markers of inflammation [ interleukin (IL)-1β , IL-6 , tumor necrosis factor (TNF)-α , C-reactive protein ( CRP ) ] and zinc transporter and metallothionein gene expression in 48 postmenopausal women with type 2 DM . No significant effects of  zinc or ALA supplementation were observed on inflammatory marker concentrations or fold change in zinc transporter and metallothionein gene expression . Significant increases in plasma zinc concentrations were observed over time in the groups supplemented with zinc alone or combined with ALA ( P=.007 and P=.009 , respectively ) . An impact of zinc treatment on zinc transporter gene expression was found ; ZnT5 was positively correlated with Zip3 mRNA ( P<.001 ) only in participants receiving zinc , while zinc supplementation abolished the relationship between ZnT5 and Zip10 . IL-6 predicted the expression levels and CRP predicted the fold change of the ZnT5 , ZnT7 , Zip1 , Zip7 and Zip10 mRNA cluster ( P<.001 and P=.031 , respectively ) . Fold change in the expression of metallothionein mRNA was predicted by TNF-α ( P=.022 ) . Associations among inflammatory cytokines and zinc transporter and metallothionein gene expression support an interrelationship between zinc homeostasis and inflammation in type 2 DM We investigated the effects of zinc supplementation on clinical observations in chronic hepatitis C patients receiving pegylated interferon ( PEG-IFN ) alpha-2b plus ribavirin combination therapy . Patients were r and omly allocated to receive 150 mg polaprezinc ( zinc group , n=11 ) or no supplement ( control group , n=12 ) daily in addition to PEG-IFN alpha-2b plus ribavirin therapy and 300 mg vitamin E and 600 mg vitamin C supplementation daily for 48 wk . Among the patients who continued treatment , the serum alanine aminotransferase ( ALT ) level at 12 wk in the zinc group was significantly lower than that in the control group . All patients in the zinc group ( 9/9 ) and 67 % ( 8/12 ) of the control patients at 24 wk , and all patients in the zinc group ( 7/7 ) and 60 % ( 6/10 ) of the control patients at 48 wk showed a decrease in serum ALT levels to within the normal range ( 7 - 44 U/L ) . HCV RNA disappeared in all patients ( 7/7 ) in the zinc group and in 8 of 10 control patients at 48 wk . Polaprezinc supplementation decreased plasma thiobarbituric acid reactive substances and prevented the decrease of polyunsaturated fatty acids of erythrocyte membrane phospholipids . No significant differences were observed in the dosage of medicines or other clinical data during the treatment . These observations indicate that polaprezinc supplementation may have induced some antioxidative functions in the liver which result ed in reduced hepatocyte injury during PEG-IFN alpha-2b plus ribavirin therapy BACKGROUND Poor growth and delayed maturation in children with sickle cell disease ( SCD ) may be due , in part , to mild zinc deficiency . OBJECTIVE The objective was to determine the effects of zinc supplementation on growth and body composition in children with SCD . DESIGN Forty-two prepubertal children ( 20 girls and 22 boys ) aged 4 - 10 y with SCD-SS were r and omly assigned to receive 10 mg elemental Zn/d in cherry syrup ( zinc group ) or cherry syrup alone ( control group ) . The 2 groups were stratified by sex and initial height status . Dietary intakes were evaluated and anthropometric , high-precision knee-height , and plasma zinc measurements were made at baseline and at 3 , 6 , and 12 mo . Body composition was determined every 6 mo with dual-energy X-ray absorptiometry , and z scores for anthropometric variables were computed from national reference data . Longitudinal-mixed-effects analysis was used to test for differences between the groups over the 12-mo observation period . RESULTS Thirty-eight children completed the study . No significant differences were observed at baseline . After 12 mo , the zinc group had significantly greater mean ( + /- SE ) increases in height ( 0.66 + /- 0.29 cm/y ) , sitting height ( 0.97 + /- 0.40 cm/y ) , knee height ( 3.8 + /- 1.2 mm/y ) , and arm circumference z scores ( 0.27 + /- 0.12 cm/y ) . Height-for-age and weight-for-age z scores decreased significantly by 0.11 + /- 0.04 and 0.13 + /- 0.05 , respectively , in the control group but did not change significantly in the zinc group . CONCLUSIONS Prepubertal children with SCD-SS may have zinc deficiency and may benefit from zinc supplementation to improve linear growth and weight gain Zinc deficiency is a common nutritional problem in adult sickle‐cell disease ( SCD ) patients . Hyperzincuria and increased requirement of zinc due to continued hemolysis in SCD are probable bases for zinc deficiency in these patients . Zinc deficiency affects adversely T‐helper1 ( TH1 ) functions and cell mediated immunity and interleukin (IL)‐2 production is decreased in zinc deficient subjects . We hypothesized that zinc supplementation will improve T‐helper1 function and decrease incidence of infections in patients with SCD . We tested this hypothesis in 32 SCD subjects who were divided in three groups ( Grs A , B , and C ) . Grs A ( n = 11 ) and B ( n = 10 ) were zinc deficient based on cellular zinc criteria and Gr C ( n = 11 ) were zinc sufficient . Gr A subjects were observed for 1 year ( baseline ) , following which they received zinc acetate ( 50 to 75 mg of elemental zinc orally daily ) for 3 years . Gr B subjects were observed for 1 year ( baseline ) , following which they received placebo for 1 year and then switched to zinc supplementation ( 50 to 75 mg of elemental zinc orally daily ) for 2 years . Gr C subjects did not receive any intervention inasmuch as they were zinc sufficient . Prolonged zinc supplementation result ed in an increase in lymphocyte and granulocyte zinc ( P = 0.0001 ) , and an increase in interleukin‐2 production ( P = 0.0001 ) , decreased incidence of documented bacteriologically positive infections ( P = 0.0026 ) , decreased number of hospitalizations and decreased number of vaso‐occlusive pain crisis ( P = 0.0001 ) . The predominant pathogens isolated were staphylococci and streptococci involving the respiratory tract and aerobic gram‐negative bacteria , particularly Escherichia coli , involving the urinary tract . Further confirmation of our observations will require prospect i ve studies of zinc supplementation in a larger number of SCD patients . Am . J. Hematol . 61:194–202 , 1999 . © 1999 Wiley‐Liss , Toxic liver diseases coincide with oxidative stress correlating positively with the seriousness of the course of disease . For the purpose of elucidating the pathogenic significance of an increased radical generation . 56 patients suffering from acute alcohol-toxic hepatitis of the clinical grade of seriousness B and C according to Child/Pugh were classified r and omly into antioxidant subgroups ( n = 31 ) and control groups (= 25 ) . The basis therapy being identical , the patients of the antioxidant group received additionally 600 mg of D-alpha tocopherol per day , 200 micrograms of selenium and 12 mg of zinc . Due to the supplementation of antioxidants there were quicker significant changes in the concentration of bilirubin , malondialdehyde and of ammonia in the serum . In comparison with the control group the length of stay in hospital could be reduced by 6 days . In the control group the mortality rates amounted to 40 % ( 10 of 25 ) , in the antioxidant group to 6.5 % ( 2 of 31 ) . The results confirm the pathogenic significance of oxidative stress in alcohol-toxic liver disease because a distinct improvement of prognosis could be achieved by using a low-cost adjuvant antioxidant supplementation BACKGROUND  Total cholesterol ( TC )  can reflect the degree of liver damage in patients with chronic hepatitis B or C ; its role in evaluating liver functional reserve and predicting postoperative complications remains unknown . METHODS The prospect ively collected data of 996 consecutive patients with chronic hepatitis B or C undergoing partial hepatectomy for hepatocellular carcinoma in a tertiary institution were retrospectively review ed . The relationship between preoperative TC and postoperative liver insufficiency , morbidity and mortality were analyzed . RESULTS TC showed significant correlation with postoperative complications on receiver operating characteristic curves , with area under the curve of 0.81 ( P < .001 ) , 0.79 ( P < .001 ) , and 0.85 ( P < .001 ) for postoperative liver insufficiency , morbidity , and mortality , respectively . Using the calculated cutoff at 2.80 mmol/L , Patients with low TC had worse preoperative liver functional reserve and suffered from more postoperative complications when compared with patients with normal TC ( ≥2.8 mmol/L ) . Multivariate analysis revealed that low preoperative TC was more powerful in predicting poor postoperative outcomes than Child-Pugh 's classification , indocyanine green ( ICG ) retention test , and Mayo End-Stage Liver Disease ( MELD ) score . It was an independent risk factor for postoperative morbidity ( odds ratio [ OR ] , 4.87 ; P < .001 ) and mortality ( OR , 14.60 ; P < .001 ) . CONCLUSION Among patients with chronic virus B or C hepatitis receiving partial hepatectomy , a low TC ( < 2.8 mmol/L ) predicted poor postoperative outcomes . It was better than Child-Pugh 's classification , ICG , and MELD score in the prediction of postoperative complications , and was useful in the preoperative evaluation of liver functional reserve One laboratory reports low activities for 2 blood copper enzymes in subjects with cystic fibrosis ( CF ) , which suggests that moderate copper deficiency is common in this state . The present study attempted to confirm this proposition in 3 ways : repeat the measures for 1 of the 2 copper enzymes ( superoxide dismutase ) in a new group of CF patients ( males and females , N = 38 ) , add another copper enzyme measure ( plasma diamine oxidase ) that has high sensitivity to copper status , and test if copper enzyme activities in CF patients rise by copper supplementation . The last test was performed plus or minus zinc supplementation since poor zinc status may contribute to poor copper status . The results for the first 2 aims supported the idea of poor copper status , as low activities were found for CF subjects for 2 copper enzyme activities , erythrocyte superoxide dismutase and plasma diamine oxidase ( although normal activities were obtained for another copper enzyme , plasma ceruloplasmin , both as U/mL plasma or U/mg ceruloplasmin immunoreactive protein ) . For the last aim , copper enzyme activities were not altered by copper supplementation ( 6 weeks , 3 mg copper/d as copper-glycinate ) , plus or minus concurrent zinc supplementation ( 30 mg zinc/d as zinc-glycinate ) . Therefore , CF may cause a tendency to moderate copper deficiency , which may be due to abnormal copper metabolism not easily corrected by increased copper and /or zinc intake BACKGROUND Studies from Asia have suggested that zinc supplementation can reduce morbidity and mortality in children , but evidence from malarious population s in Africa has been inconsistent . Our aim was to assess the effects of zinc supplementation on overall mortality in children in Pemba , Zanzibar . METHODS We enrolled 42,546 children aged 1 - 36 months , contributing a total of 56,507 child-years in a r and omised , double-blind , placebo-controlled trial in Pemba , Zanzibar . R and omisation was by household . 21 274 children received daily supplementation with zinc 10 mg ( 5 mg in children younger than 12 months ) for mean 484.7 days ( SD 306.6 ) . 21,272 received  placebo . The primary endpoint was overall mortality , and analysis was by intention to treat . This study is registered as an International St and ard R and omised Clinical Trial , number IS RCT N59549825 . FINDINGS Overall , there was a non-significant 7 % ( 95 % CI -6 % to 19 % ; p=0.29 ) reduction in the relative risk of all-cause mortality associated with zinc supplementation . INTERPRETATION We believe that a meta- analysis of all studies of mortality and morbidity , will help to make evidence -based recommendations for the role of zinc supplementation in public health policy to improve mortality , morbidity , growth , and development in young children BACKGROUND Adequate zinc is critical for immune function ; however , zinc deficiency occurs in > 50 % of human immunodeficiency virus (HIV)-infected adults . We examined the safety and efficacy of long-term zinc supplementation in relation to HIV disease progression . METHODS A prospect i ve , r and omized , controlled clinical trial was conducted involving 231 HIV-infected adults with low plasma zinc levels ( < 0.75 mg/L ) , who were r and omly assigned to receive zinc ( 12 mg of elemental zinc for women and 15 mg for men ) or placebo for 18 months . The primary end point was immunological failure . HIV viral load and CD4(+ ) cell count were determined every 6 months . Question naires , pill counts , and plasma zinc and C-reactive protein levels were used to monitor adherence to study supplements and antiretroviral therapy . Intent-to-treat analysis used multiple-event analysis , treating CD4(+ ) cell count < 200 cells/mm(3 ) as a recurrent immunological failure event . Cox proportional hazard models and the general-linear model were used to analyze morbidity and mortality data . RESULTS Zinc supplementation for 18 months reduced 4-fold the likelihood of immunological failure , controlling for age , sex , food insecurity , baseline CD4(+ ) cell count , viral load , and antiretroviral therapy ( relative rate , 0.24 ; 95 % confidence interval , 0.10 - 0.56 ; P<.002 ) . Viral load indicated poor control with antiretroviral therapy but was not affected by zinc supplementation . Zinc supplementation also reduced the rate of diarrhea by more than half ( odds ratio , 0.4 ; 95 % confidence interval , 0.183 - 0.981 ; P=.019 ) , compared with placebo . There was no significant difference in mortality between the 2 groups . CONCLUSIONS This study demonstrated that long-term ( 18-month ) zinc supplementation at nutritional levels delayed immunological failure and decreased diarrhea over time . This evidence supports the use of zinc supplementation as an adjunct therapy for HIV-infected adult cohorts with poor viral control . Trial registration . Clinical Trials.gov identifier : NCT00149552
Clinical trials assessing zinc supplementation in liver diseases do not show benefits in terms of clinical improvement or disease halting .
There are possible benefits of zinc supplementation on hepatic encephalopathy , however , this is based on limited evidence .
INTRODUCTION AND OBJECTIVES Zinc deficiency has been associated with poor prognosis in chronic liver disease .
This systematic review and meta- analysis aim ed to evaluate the role of zinc supplementation in the management of chronic liver diseases .