Global and regional child mortality and burden of disease attributable to zinc deficiency Additional zinc delivered in a liquid supplement, but not in a fortified porridge, increased fat-free mass accrual among young Peruvian children with mild-to-moderate stunting. Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial Effect of daily and weekly micronutrient supplementation on micronutrient deficiencies and growth in young Vietnamese children. Comparison of the effects of zinc delivered in a fortified food or a liquid supplement on the growth, morbidity, and plasma zinc concentrations of young Peruvian children. Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican preschoolers. Effect of zinc supplementation on growth and body composition in children with sickle cell disease. Effects of repletion with zinc and other micronutrients on neuropsychologic performance and growth of Chinese children. Zinc supplementation in young children with acute diarrhea in India. Effect on longitudinal growth and anemia of zinc or multiple micronutrients added to vitamin A: a randomized controlled trial in children aged 6-24 months Longitudinal measures of circulating leptin and ghrelin concentrations are associated with the growth of young Peruvian children but are not affected by zinc supplementation. Randomized controlled trial of the effect of daily supplementation with zinc or multiple micronutrients on the morbidity, growth, and micronutrient status of young Peruvian children. Effect of vitamin-enriched bread on the vitamin status of an isolated rural community--a controlled clinical trial. Mild to moderate zinc deficiency in short children: effect of zinc supplementation on linear growth velocity. Iron and zinc supplementation improved iron and zinc status, but not physical growth, of apparently healthy, breast-fed infants in rural communities of northeast Thailand. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. Evaluation of nutritional status and pathophysiology of growth retardation in patients with phenylketonuria Linear growth of low income preschool children receiving a zinc supplement. Effect of zinc supplementation on mortality in children aged 1–48 months: a community-based randomised placebo-controlled trial Effect of Zinc Supplementation on Growth Hormone Secretion, IGF-I, IGFBP-3, Somatomedin Generation, Alkaline Phosphatase, Osteocalcin and Growth in Prepubertal Children with Idiopathic Short Stature Randomised comparison of the effects of Sprinkles and Foodlets with the currently recommended supplement (Drops) on micronutrient status and growth in Iranian children Zinc supplementation increases growth and circulating insulin-like growth factor I (IGF-I) in growth-retarded Vietnamese children. 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.
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 The exact mechanism whereby zinc influences growth is unknown , although it has been postulated that zinc may stimulate appetite and energy intake or enhance fat-free mass ( FFM ) accrual directly . We compared energy intake , reported appetite , and body composition of 6- to 8-mo-old Peruvian children with initial length-for-age Z-score ( LAZ ) < -0.5 SD who were r and omly assigned to receive daily for 6 mo : 1 )  3 mg/d zinc in a liquid supplement ; 2 )  3 mg/d zinc in a fortified porridge ; or 3 ) no extra zinc in either the supplement or porridge . There were no group-wise differences in changes in dietary energy intakes or body composition or in the prevalence of reported poor appetite . However , among children with an initial LAZ less than the median ( -1.1 SD ) , those who received zinc as a liquid supplement had a 0.41 kg greater increase in FFM than those who did not receive zinc ( P < 0.05 ) . We concluded that daily provision of 3 mg of supplemental zinc did not affect energy intake or reported appetite . Among children with initial mild-to-moderate stunting , those who received the zinc supplement had a greater increase in FFM than those who did not receive additional zinc . It is possible that the growth-restricted children were more likely to be zinc deficient and that FFM accrual may be an early growth response to supplemental zinc . Zinc supplements may be more efficacious than the same dose of zinc provided in fortified food ; therefore , further research is needed on the optimal level of zinc fortification that will result in improved health outcomes in population s with high rates of zinc deficiency BACKGROUND Stunting is highly prevalent in Ethiopia and many other developing countries but the reason for it is poorly understood . Zinc is essential for growth but diets in such countries often do not contain zinc in sufficient quantity or of sufficient bioavailability . Thus zinc deficiency may play a major role in stunting . The aim of the study was to investigate whether the low rate of linear growth of apparently healthy breastfed infants in a rural village in Ethiopia could be improved by zinc supplementation . METHODS A r and omised , double-blind , placebo-controlled trial was done on apparently healthy breastfed infants aged 6 - 12 months . 100 non-stunted ( length-for-age , Z score < -2 ) were matched for age and sex with 100 r and omly selected stunted ( > -2 ) infants . Infants , both stunted and non stunted , were matched by sex , age ( within 2 months ) and recumbent length ( within 3 cm ) for r and om assignment , to receive a zinc supplement ( 10 mg zinc per day , as zinc sulphate ) or placebo , 6 days a week for 6 months . Anthropometric measurements were taken monthly , data on illness and appetite were collected daily , and sample s of serum and hair were taken at the end of the intervention for the analysis of zinc . FINDINGS The length of stunted infants increased significantly more ( p<0.001 ) when supplemented with zinc ( 7.0 cm [ SE 1.1 ] ) than with placebo ( 2.8 cm [ 0.9 ] ) ; and the effect was greater ( p<0.01 ) than in non-stunted infants ( 6.6 [ 0.9 ] vs 5.0 [ 0.8 ] cm for the zinc and placebo groups respectively , p<0.01 ) . Zinc supplementation also increased the weight of stunted children ( 1.73 [ 0.39 ] vs 0.95 [ 0.39 ] kg for the corresponding placebo group , p<0.001 ) and of non-stunted children ( 1.19 [ 0.39 ] vs 1.02 [ 0.32 ] kg for the corresponding placebo group , p<0.05 ) . Zinc supplementation result ed in a markedly lower incidence of anorexia and morbidity from cough , diarrhoea , fever , and vomiting in the stunted children . The total number of these conditions per child was 1.56 and 1.11 in the stunted and non-stunted zinc supplemented children versus 3.38 and 1.64 in the stunted and non-stunted placebo-treated children , respectively . At the end of the intervention period , the concentrations of zinc in serum and hair of stunted infants , who had not been supplemented with zinc , were lower than the respective concentrations of zinc in serum and hair of their non-stunted counterparts . INTERPRETATION Combating zinc deficiency can increase the growth rate of stunted children  to that of non-stunted infants in rural Ethiopia . This would appear to be due , at least in part , to reduction in morbidity from infection and increased appetite BACKGROUND Micronutrient deficiencies remain common in preschool children in developing countries . Interventions focus on single micronutrients and often lack effectiveness . Weekly instead of daily supplementation may improve effectiveness . OBJECTIVE The efficacy of weekly and daily supplementation in reducing anemia prevalence and in improving the zinc , vitamin A , and growth status of 6 - 24-mo-old Vietnamese children was investigated . DESIGN In this double-blind , placebo-controlled trial , the daily group ( n = 55 ) received 8 mg elemental Fe ( as iron sulfate ) , 5 mg elemental Zn ( as zinc sulfate ) , 333 microg retinol , and 20 mg vitamin C 5 d/wk for 3 mo . The weekly group ( n = 54 ) received 20 mg Fe , 17 mg Zn , 1700 microg retinol , and 20 mg vitamin C once a week . A third group ( n = 54 ) received a placebo only .  Venous blood sample s were collected at the start and end of the supplementation period and anthropometric measurements were taken at the start and 3 mo after the end of supplementation . RESULTS At baseline , 45.6 % of subjects had hemoglobin concentrations < 110 g/L , 36.3 % had zinc concentrations < 10.71 micromol/L , and 45.6 % had retinol concentrations < 0.70 micromol/L. Hemoglobin , retinol , and zinc concentrations of both the weekly and daily groups increased similarly compared with the placebo group ( P < 0.001 ) . There was no significant difference in growth between the supplemented groups and the placebo group . However , the height-for-age of subjects stunted at baseline increased with z scores of 0.48 ( P < 0.001 ) and 0.37 ( P < 0.001 ) for the daily and weekly groups , respectively . CONCLUSIONS Weekly and daily supplementation improved hemoglobin , zinc , and retinol concentrations similarly . Neither intervention affected growth of the overall population , but growth of children stunted at baseline was improved through both types of supplementation BACKGROUND Zinc supplementation decreases morbidity from infections and increases growth of stunted children  , but there is little information on functional responses to zinc delivered in fortified foods . OBJECTIVE The aim was to examine the effects of zinc fortification on the growth , morbidity from infections , and plasma zinc concentrations of young children . DESIGN We compared the physical growth , morbidity , and micronutrient status of 6 - 8-mo-old Peruvian children with initial length-for-age z score ( LAZ ) < -0.50 who were r and omly assigned to receive one of the following treatments daily for 6 mo : 1 ) 30 g dry weight of an iron-fortified cereal porridge and a separate dose of an aqueous multivitamin ( MV ) supplement between meals ( control group ) , 2 ) the same porridge and MV with 3 mg Zn added to the supplement dose ( ZnSuppl group ) , or 3 ) the porridge with added zinc ( 150 mg/kg dry weight ) and MV without zinc ( ZnFort group ) . RESULTS The children consumed a mean of 22 - 26 g dry porridge/d and 96 % of the possible MV doses . After adjustment for small baseline differences in socioeconomic status and morbidity , no significant differences in weight or length increments were observed between the groups , even among the subset with an initial LAZ < -1.5 , and no significant differences in the rates of common illnesses were observed . Mean plasma zinc concentrations decreased in the control group ( -3.9 microg/dL ) , increased in the ZnSuppl group ( 4.3 microg/dL ) , and did not change significantly in the ZnFort group ( -1.5 microg/dL ; P < 0.001 for group-wise comparison ) . CONCLUSIONS Provision of additional zinc , either in an aqueous supplement or a fortified porridge , did not significantly affect the children 's physical growth or morbidity from infections , possibly because they were not sufficiently growth-restricted or zinc-deficient initially or because the level of zinc intake or absorption was inadequate . Additional studies of the functional effect of zinc-fortified foods are needed in population s that are known to respond to zinc supplements In rural Mexico and in many developing countries micronutrient deficiencies , growth stunting , and morbidity from infectious diseases are highly prevalent in young children . We assessed the extent to which growth stunting could be reversed and the number of infectious disease episodes reduced by zinc and /or iron supplementation . In a double-blind , r and omized community trial 219 Mexican preschoolers were supplemented with either 20 mg Zn as zinc methionine , 20 mg Fe as ferrous sulfate , 20 mg Zn + 20 mg Fe , or a placebo . After 12 mo , plasma zinc increased significantly in the two zinc-treated groups , and plasma ferritin was significantly higher in the two iron-treated groups . There was no effect of treatments on growth velocity or body composition . Children in both zinc-supplemented groups had fewer episodes of disease ( zinc alone , 3.9 + /- 0.3 ; zinc+iron , 3.7 + /- 0.4 ; placebo , 4.6 + /- 0.5 ; P < 0.03 ) , including diarrhea ( zinc alone , 0.7 + /- 0.1 ; zinc+iron , 0.8 + /- 0.1 ; placebo , 1.1 + /- 0.2 ; P < 0.01 ) . Zinc and zinc+iron supplements reduced morbidity but had no effect on growth or body composition 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 The knowledge that zinc is essential for growth and neuropsychologic performance and a report of zinc-responsive stunting in Chinese children prompted this project . This article summarizes findings from a 10-wk , double-blind , controlled trial of zinc repletion in 740 urban , 6 - 9-y-old first grade rs from low-income families in Chongqing , Qingdao , and Shanghai , People 's Republic of China . Treatments were 20 mg Zn alone ( Z ) , 20 mg Zn with micronutrients ( ZM ) , and micronutrients alone ( M ) . The M mixture was based on National Research Council guidelines . Nutrients that might interfere with zinc retention were excluded or given in lower amounts . Main outcomes were changes in neuropsychologic performance and knee height . Hemoglobin , serum ferritin , plasma and hair zinc , and whole blood and hair lead were also measured . Anemia was not common , and serum ferritin concentrations were usually within the range of normal . Mean baseline plasma zinc concentrations were marginal in children from Chongqing and Qingdao and normal in children from Shanghai . After treatment with ZM or M plasma zinc increased . Hair zinc tended to decrease after all treatments . Mean baseline whole blood lead concentrations were slightly below the limit considered excessive for children by the US Centers for Disease Control and Prevention . Neuropsychologic performance and growth were most improved after treatment with ZM . These findings were consistent with the presence of zinc and other micronutrient deficiencies BACKGROUND In developing countries the duration and severity of diarrheal illnesses are greatest among infants and young children with malnutrition and impaired immune status , both factors that may be associated with zinc deficiency . In children with severe zinc deficiency , diarrhea is common and responds quickly to zinc supplementation . METHODS To evaluate the effects of daily supplementation with 20 mg of elemental zinc on the duration and severity of acute diarrhea , we conducted a double-blind , r and omized , controlled trial involving 937 children , 6 to 35 months of age , in New Delhi , India . All the children also received oral rehydration therapy and vitamin supplements . RESULTS Among the children who received zinc supplementation , there was a 23 percent reduction ( 95 percent confidence interval , 12 percent to 32 percent ) in the risk of continued diarrhea . Estimates of the likelihood of recovery according to the day of zinc supplementation revealed a reduction of 7 percent ( 95 percent confidence interval , -9 percent to + 22 percent ) in the risk of continued diarrhea during days 1 through 3 and a reduction of 38 percent ( 95 percent confidence interval , 27 percent to 48 percent ) after day 3 . When zinc supplementation was initiated within three days of the onset of diarrhea , there was a 39 percent reduction ( 95 percent confidence interval , 7 percent to 61 percent ) in the proportion of episodes lasting more than seven days . In the zinc-supplementation group there was a decrease of 39 percent ( 95 percent confidence interval , 6 percent to 70 percent ) in the mean number of watery stools per day ( P = 0.02 ) and a decrease of 21 percent ( 95 percent confidence interval , 10 percent to 31 percent ) in the number of days with watery diarrhea . The reductions in the duration and severity of diarrhea were greater in children with stunted growth than in those with normal growth . CONCLUSION For infants and young children with acute diarrhea , zinc supplementation results in clinical ly important reductions in the duration and severity of diarrhea Background The benefits of zinc or multiple micronutrient supplementations in African children are uncertain . African children may differ from other population s of children in developing countries because of differences in the prevalence of zinc deficiency , low birth weight and preterm delivery , recurrent or chronic infections such as HIV , or the quality of complementary diets and genetic polymorphisms affecting iron metabolism . The aim of this study was to ascertain whether adding zinc or multiple micronutrients to vitamin A supplementation improves longitudinal growth or reduces prevalence of anemia in children aged 6 - 24 months . Methods R and omized , controlled double-blinded trial of prophylactic micronutrient supplementation to children aged 6 - 24 months . Children in three cohorts - 32 HIV-infected children , 154 HIV-uninfected children born to HIV-infected mothers , and 187 uninfected children born to HIV-uninfected mothers - were separately r and omly assigned to receive daily vitamin A ( VA ) [ n = 124 ] , vitamin A plus zinc ( VAZ ) [ n = 123 ] , or multiple micronutrients that included vitamin A and zinc ( MM ) [ n = 126 ] . Results Among all children there were no significant differences between intervention arms in length-for-age Z scores ( LAZ ) changes over 18 months . Among stunted children ( LAZ below -2 ) [ n = 62 ] , those receiving MM had a 0.7 Z-score improvement in LAZ versus declines of 0.3 in VAZ and 0.2 in VA ( P = 0.029 when comparing effects of treatment over time ) . In the 154 HIV-uninfected children , MM ameliorated the effect of repeated diarrhea on growth . Among those experiencing more than six episodes , those receiving MM had no decline in LAZ compared to 0.5 and 0.6 Z-score declines in children receiving VAZ and VA respectively ( P = 0.06 for treatment by time interaction ) . After 12 months , there was 24 % reduction in proportion of children with anemia ( hemoglobin below 11 g/dL ) in MM arm ( P = 0.001 ) , 11 % in VAZ ( P = 0.131 ) and 18 % in VA ( P = 0.019 ) . Although the within arm changes were significant ; the between-group differences were not significant . Conclusions Daily multiple micronutrient supplementation combined with vitamin A was beneficial in improving growth among children with stunting , compared to vitamin A alone or to vitamin A plus zinc . Effects on anemia require further study .Trial registration This study is registered with Clinical Trials.gov , number .NCT00156832 BACKGROUND Leptin , ghrelin , and insulin are hormonal regulators of energy balance and , therefore , may be related to growth during infancy . Zinc is essential for growth , and its growth effects may be mediated through these hormones . OBJECTIVE We examined the effects of supplemental zinc on plasma leptin , ghrelin , and insulin concentrations among young children at risk of zinc deficiency and examined the relations between these hormones and physical growth . DESIGN Children ( n = 142 ) aged 6 - 8 mo were r and omly assigned to receive 3 mg Zn/d as a supplement , in a fortified food , or as a placebo for 6 mo . Relations between hormones and anthropometric z scores , body composition , and growth rates were examined at baseline and 3 and 6 mo after the start of the intervention . RESULTS No treatment group-related differences were found in plasma leptin , ghrelin , or glucose concentrations or in anthropometric z scores at 3 or 6 mo after the start of the zinc intervention . Neither plasma leptin nor ghrelin concentrations at baseline or 3 mo were predictive of subsequent changes in growth . However , changes in weight-for-age z scores over the two 3-mo time intervals were positively associated with subsequent leptin concentrations and inversely associated with subsequent plasma ghrelin concentrations . CONCLUSIONS Supplemental zinc did not affect the children 's  growth , anthropometric indexes , or plasma hormone concentrations in this study population . Our results suggest that plasma leptin and ghrelin concentrations in later infancy are a consequence of previous weight changes rather than predictors of short-term growth BACKGROUND Zinc supplements reduce  childhood morbidity in population s in whom zinc deficiency is common . In such population s , deficiencies in other micronutrients may also occur . OBJECTIVE The objective was to determine whether the administration of other micronutrients with zinc modifies the effect of  zinc supplementation on children 's morbidity and physical growth . DESIGN Two hundred forty-six children aged 6 - 35 mo with persistent diarrhea were r and omly assigned to 1 of 3 groups to receive a daily supplement of 10 mg Zn alone ( Zn ; n = 81 ) , zinc plus vitamins and other minerals at 1 - 2 times recommended daily intakes ( Zn+VM ; n = 82 ) , or placebo ( n = 83 ) for approximately 6 mo after the diarrhea episode ended . Morbidity information was collected on weekdays . Weight , length , and other anthropometric indicators were measured monthly , and plasma zinc and other indicators of micronutrient status were measured at baseline and 6 mo . RESULTS Supplement consumption was high ( approximately 90 % ) in all groups , although slightly more vomiting was reported in the Zn+VM group ( P < 0.0001 , analysis of variance ) . The change in plasma zinc from baseline to 6 mo was greater in the 2 zinc groups ( 6.1 , 27.3 , and 16.2 micro g/dL in the placebo , Zn , and Zn+VM groups , respectively ; P < 0.0001 , analysis of variance ) . The Zn group had fewer episodes of diarrhea , dysentery , and respiratory illness and a lower prevalence of fever and cough than did the Zn+VM group and a lower prevalence of cough than did the placebo group ( P = 0.05 ) . No significant effects of supplementation on growth were observed . CONCLUSION Morbidity was greater after supplementation with zinc plus multivitamins and minerals than it was after supplementation with zinc alone Malnutrition is an inclusive term that entails the lack , excess or imbalance of one or more nutrients required to maintain normal nutritional status and optimal health . Malnutrition affects a large segment of the world 's children . 1 It is estimated that the prevalence of childhood malnutrition in South Africa ranges from 5 % to 50 % of the current poputation.2 It is well documented that an inadequate intake of micronutrients causes deficiency disorders and that such deficiencies often accompany malnutrTtion . 3 The dietary intake of calcium , iron , zinc , folic acid , riboflavin , vitamin 86 and vitamin C  has been reported to be low , in comparison with the recommended dietary allowances (RDA),4 in a significant proportion of children in the country ; it is often lower than 67 % of the RDA , indicating a population at risk of deficiency.s » In adults 15 - 64 years of age , the dietary intake of such micronutrients as vitamin 8 6 , iron , calcium , magnesium , zinc , copper and folic acid  has also been reported to be significantly lower than the RDA.S , S Fortification of food staples has been successfully implemented in a number of countries to increase the dietary intake of micronutrients . Twenty-one prepubertal , short Japanese children ( 11 boys ) without endocrine abnormalities were identified as having mild-to-moderate zinc deficiency by zinc kinetics studies ( zinc body clearance > or = 20 ml/kg per hour ) . Only one child had a serum zinc level < 65 micrograms/dl ( cutoff level ) . A total of 10 children ( 5 boys ) received 5 mg/kg per day of zinc sulfate for 6 months ; 11 untreated children ( 6 boys ) served as control subjects . During treatment , calorie intake ( p < 0.01 ) , growth velocity ( p < 0.01 ) , serum zinc , calcium , and phosphorus concentrations , alkaline phosphatase activity ( p < 0.001 ) , percentage of tubular reabsorption of phosphorus ( p < 0.05 ) , ratio of maximal tubular reabsorption rate for phosphorus to the glomerular filtration rate ( p < 0.05 ) , serum osteocalcin level ( p < 0.01 ) , and plasma insulin-like growth factor 1 ( p < 0.05 ) were significantly increased , but urinary excretion of growth hormone was unchanged in the zinc-supplemented group . All these values were unchanged in the untreated children . We conclude that zinc supplementation is effective for inducing growth in short children with zinc deficiency , and that body zinc clearance tests facilitate detection of marginal zinc deficiency Iron deficiency is prevalent in children and infants worldwide . Zinc deficiency may be prevalent , but data are lacking . Both iron and zinc deficiency negatively affect growth and psychomotor development . Combined iron and zinc supplementation might be beneficial , but the potential interactions need to be verified . In a r and omized , placebo-controlled trial using 2 x 2 factorial design , 609 Thai infants aged 4 - 6 mo were supplemented daily with 10 mg of iron and /or 10 mg of zinc for 6 mo to investigate effects and interactions on micronutrient status and growth . Iron supplementation alone increased hemoglobin and ferritin concentrations more than iron and zinc combined . Anemia prevalence was significantly lower in infants receiving only iron than in infants receiving iron and zinc combined .  Baseline iron deficiency was very low , and iron deficiency anemia was almost nil . After supplementation , prevalence of iron deficiency and iron deficiency anemia were significantly higher in infants receiving placebo and zinc than in those receiving iron or iron and zinc .  Serum zinc was higher in infants receiving zinc ( 16.7 + /- 5.2 micromol/L ) , iron and zinc ( 12.1 + /- 3.8 micromol/L ) or iron alone ( 11.5 + /- 2.5 micromol/L ) than in the placebo group ( 9.8 + /- 1.9 micromol/L ) . Iron and zinc interacted to affect iron and zinc status , but not hemoglobin . Iron supplementation had a small but significant effect on ponderal growth , whereas zinc supplementation did not . To conclude , in Thai infants , iron supplementation improved hemoglobin , iron status , and ponderal growth , whereas zinc supplementation improved zinc status . Overall , for infants , combined iron and zinc supplementation is preferable to iron or zinc supplementation alone Although iron deficiency is the most common single-nutrient deficiency in infants and children , other deficiencies may develop concurrently , including zinc deficiency . In previous studies , we used home-fortification with " Sprinkles , " single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods , to successfully treat anemia . This mode of micronutrient delivery is amenable to the delivery of other micronutrients . However , the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions . Thus , we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants , compared with Sprinkles formulated with iron alone . We studied 304 anemic infants ( mean age 10.3 + /- 2.5 mo ; hemoglobin 87.4 + /- 8.4 g/L ) in rural Ghana . A combined supplementation group ( FeZn ) received daily Sprinkles containing 80 mg iron and 10 mg zinc ; a comparison group ( Fe ) received Sprinkles ( 80 mg iron ) without zinc for 2 mo . The rate of recovery from anemia was higher in the Fe group compared with the FeZn group ( 74.8 vs. 62.9 % ; P = 0.048 ) . The plasma zinc concentration decreased significantly in both groups ( P < 0.05 ) . A significant decline in the height for age Z-score was observed in the FeZn group ( P = 0.0011 ) , but there was no change in the Fe group . These results suggest that in a controlled setting , home-fortification using micronutrient Sprinkles with iron , or iron and zinc , was very successful in treating anemia ; however , this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population Summary : Recent European studies have shown that growth retardation is common in people with phenylketonuria ( PKU ) during the first years of life while they receive a  low-phenylalanine ( Phe ) diet . The aims of the present study were to assess the growth of our PKU patients and to search for nutritional and hormonal explanations for the growth delay . Twenty PKU patients aged 8 months to 7 years entered the study . The design was cross-sectional , a longitudinal study having already been performed in our centre . The following data were recorded : weight/height ( W/H ) , height/age ( H/A ) , and weight/age ( W/A ) Z-scores ; fat-free mass ( measured from bioelectrical impedometry ( FFM1 ) , and skinfold thickness ( FFMA ) . Thyroid hormones , insulin-like growth factor I ( IGF1 ) , insulin-like growth factor binding protein ( IGFBP3 ) , selenium , zinc , and Phe blood levels were measured . Dietary intake was also recorded over 4 days . PKU patients were moderately but significantly shorter ( H/A Z-score varied from −2.12 to 1.61 ; mean −0.49 ) and lighter ( W/A Z-score varied from −2.58 to 1.49 ; mean −0.71 ) than the French reference population . Body composition was not different from that of controls matched for age and sex . IGF1 , IGFBP3 , and thyroid hormone levels were within normal range . All children received more than two-thirds of the recommended daily allowances for energy ( 91%±18 % ) and for proteins ( 146%±26 % ) . The mean daily intake of our patients was sufficient in selenium , but markedly deficient in zinc ( 2.4±2.2 mg/day ) . No correlation was found between zinc daily intake or zinc plasma levels and growth retardation . Moreover , no relation was found between the plasma Phe concentrations , protein or caloric intake and the presence of growth retardation . Our results show that growth retardation in PKU patients is not related to hormonal or caloric deficiencies . Further studies are needed to investigate the effect of various nutrient supplementation regimens ( especially zinc ) on the growth of PKU patients The effects of a zinc supplement on growth velocity were assessed in a double-blind , pair-matched controlled study in 40 children with low growth percentiles . Participants were low-income Spanish-American children , 2 to 6 yr of age with heights below the 10th percentile and nutritional or biochemical evidence of zinc deficiency . After 1 yr , the mean height velocity of the zinc-supplemented children was slightly , but significantly ( p less than 0.005 ) , greater than that of control children . This effect was primarily due to a greater height achievement of the zinc-supplemented boys . Increases in height-for-age z-scores were also significant for the supplemented males ( p less than 0.001 ) and for the combined sexes ( p less than 0.05 ) . This study indicates the existence of a growth-limiting syndrome of mild zinc deficiency in children 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 Controversy exists about the effect of zinc on growth and the GH-IGF system .  Zinc supplementation has been shown to stimulate linear growth in zinc-deficient children . However the mechanism of this effect has not been well characterized . Furthermore , the effect of zinc supplementation on non-zinc-deficient short children is unknown . We investigated the effect of zinc supplementation on endogenous GH secretion , serum IGF-I and IGFBP-3 concentrations , IGF-I and IGFBP-3 generation in response to exogenous GH , bone formation markers , and linear growth of non-zinc-deficient children with idiopathic short stature . We analyzed prospect ively serum zinc , IGF-I , IGFBP-3 , alkaline phosphatase , osteocalcin , and GH response to clonidine test  , and performed a somatomedin generation test before and 6 weeks after zinc supplementation in 22 ( 16 M , 6 F ) prepubertal children with idiopathic short stature .  Serum IGF-I increased from 67.4+/-70.6 to 98.2+/-77.3 ng/ml ( p < 0.001 ) , IGFBP-3 from 2326+/-770 to 2758+/-826 ng/ml ( p < 0.001 ) , alkaline phosphatase from 525+/-136 to 666+/-197 U/l ( p < 0.0001 ) , and osteocalcin from 16.8+/-10.6 to 25.8+/-12.8 ng/ml ( p < 0.05 ) after zinc supplementation despite there being no difference in GH response to clonidine after zinc supplementation ( peak GH 11.6+/-6.9 vs 13.4+/-7.8 ng/ml , GH area under the curve during clonidine test 689+/-395 vs 761+/-468 , NS ) . Percent change in IGF-I and IGFBP-3 during the somatomedin generation test was not significantly affected by zinc supplementation ( 118 % vs 136 % and 57 % vs 44 % , respectively ) . There was no significant correlation between percentage increase in zinc levels and percentage increase in parameters tested . Height SDS or weight SDS did not improve significantly in 17 patients who continued on zinc supplementation for at least 6 months ( 6 - 12 months ) ( -2.59 vs -2.53 SDS and -1.80 vs -1.67 SDS , respectively ) . Zinc supplementation increased basal IGF-I , IGFBP-3 , alkaline phosphatase and osteocalcin without changing GH response to clonidine . Zinc supplementation did not affect sensitivity to exogenous GH as tested by IGF-I and IGFBP-3 generation test . These results suggest a direct stimulatory effect of zinc on serum IGF-IGFBP-3 , alkaline phosphatase and osteocalcin . Despite improvements in the above parameters , zinc supplementation to children with idiopathic short stature with normal serum zinc levels did not significantly change height or weight SDS during 6 - 12 months follow-up Background / Objectives : Multiple micronutrient supplementation with Sprinkles powder and crushable Foodlets tablets may be effective means of controlling micronutrient deficiencies in infants . Their efficacy has not been tested in countries like Iran where wheat as the staple food may affect nutrient bioavailability . This study aim ed to compare the efficacy of Sprinkles , Foodlets and the current supplement ( Drops ) for improving micronutrient status and growth among Iranian infants . Subjects/ Methods : Infants of 6–18 months of age , living in an urban district of Iran were r and omised to receive daily Sprinkles ( n=120 ) , Foodlets ( n=121 ) or Drops ( n=121 ) for 4 months . Haemoglobin ( Hb ) , serum ferritin , serum retinol , serum zinc , 25(OH ) D concentration and anthropometry were assessed at baseline and at 4 months . Results : Iron status improved with all treatments . Drops showed significantly greater changes in Hb and serum ferritin , though changes in anaemia prevalence were not different across groups . Infants having Foodlets and Sprinkles had significantly greater reductions in proportion of children with zinc deficiency compared with Drops . No significant differences in treatment effects were observed for mean serum 25(OH ) D and retinol , or for growth of infants across groups . Conclusion : The study was the first efficacy trial with Sprinkles and Foodlets in the Middle East where wheat or rice is the principal complementary foods . Differences across treatment groups were largely consistent with supplement micronutrient composition for iron and zinc , with no benefit in this population for serum retinol , 25(OH ) D , growth or anthropometric status . The trial identified trade-offs in combining multiple micronutrients in a single delivery mechanism To determine whether zinc deficiency might be involved in the failure to thrive observed in undernourished Vietnamese children , we assessed growth , incidence of infections , and circulating insulin-like growth factor I ( IGF-I ) concentrations in a double-blind study of zinc supplementation .  Growth-retarded children ( n=146 ) aged 4 - 36 mo were paired according to age , sex , commune , Z scores for weight ( WAZ ) and for height ( HAZ ) , and number of siblings , and were r and omly assigned to receive either 153 micromol ( 10 mg ) Zn/d or a placebo for 5 mo . Weight , height , and episodes of infection were recorded each month and plasma IGF-I was measured 1 and 5 mo after the start of zinc supplementation . Multiple-linear-regression analysis for paired data showed that zinc supplementation increased weight ( + 0.5 + /- 0.1 kg ; P<0.001 ) and height ( + 1.5+/-0.2 cm ; P<0.001 ) after 5 mo compared with placebo treatment . The relative risk of infectious episodes in the zinc-treated subjects was reduced 3-fold for diarrhea ( P=0.012 ) and 2.5-fold for respiratory infections ( p=0.057 ) . The probability of having at least two episodes of diarrhea or respiratory infection was 2.9- and 3.2-fold lower , respectively , in zinc-treated subjects between 1 and 5 mo ( P=0.018 ) , whereas they did not change in placebo-treated subjects ( P-0.584 ) . After 1 mo , IGF-I concentration ( -x+/-SD ) in zinc-treated subjects was 2.8+/-0.3 nmol/L compared with 1.9+/-0.2 nmol/L in placebo-treated subjects ( P=0.021 ) . After 5 mo , the values were 3.4+/-0.5 nmol/L ( zinc-treated ) and 2.0+/-0.3 nmol/L ( placebo-treated ; P=0.044 ) . Our study suggests that zinc deficiency may limit growth in nutritionally deprived children . Because the increase in growth velocity result ing from zinc supplementation was associated with increased plasma IGF-I concentrations , we suggest that the growth-stimulating effect of zinc might be mediated through changes in circulating 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 r and omized , 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 mug/L ) was significantly less than that in the other 2 groups ( 33.0 and 30.8 mug/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
Conclusions : Many of the children in the included studies were already stunted and may have been suffering from multiple micronutrient deficiencies , and therefore zinc supplementation alone may have only a limited effect on growth
Background / objectives : It is estimated that zinc deficiency affects 17 % of the world 's population , and because of periods of rapid growth children are at an increased risk of deficiency , which may lead to stunting .
This paper presents a systematic review and meta- analysis of the r and omised controlled trials ( RCTs ) that assess zinc intake and growth in children aged 1–8 years .