This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bhutta, Z. A.
Right arrow Articles by Isani, Z.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bhutta, Z. A.
Right arrow Articles by Isani, Z.
Related Collections
Right arrow Nutrition & Metabolism

PEDIATRICS Vol. 103 No. 4 April 1999, p. e42

ELECTRONIC ARTICLE:
Zinc Supplementation in Malnourished Children With Persistent Diarrhea in Pakistan

Received Apr 16, 1998; accepted Nov 30, 1998.

Zulfiqar Ahmed Bhutta*, Shaikh Qamaruddin Nizami*, and Zeenat IsaniDagger

From the * Department of Pediatrics, Aga Khan University Medical Center, Karachi; and the Dagger  National Institute of Child Health, Karachi, Pakistan.

Objective.  To evaluate the potential benefit of dietary supplementation of a rice-lentil (Khitchri) and yogurt diet with 3 mg/kg/d of elemental zinc (as zinc sulfate) in hospitalized malnourished children (age 6-36 months) with persistent diarrhea for 14 days.

Methodology.  Randomized, double-blind placebo-controlled trial.

Setting.  Nutrition Research Ward at the National Institute of Child Health, Karachi, Pakistan, where children were admitted for 14 days of inpatient supervised rehabilitation.

Main Outcome Measures.  Primary outcome: overall weight gain by day 14. Secondary outcomes: overall energy intake, stool output, time to diarrheal recovery and weight gain (>= 3 days), plasma zinc, copper, prealbumin, and insulin-like growth factor-1.

Results.  Of 87 children randomized for supplementation with either zinc or placebo, the two groups were comparable at admission in terms of severity and duration of diarrhea, as well as nutritional and anthropometric parameters. The overall weight gain, stool volume, stool frequency, as well as the time taken for diarrheal recovery or steady weight gain, were comparable for both supplemented children and controls. Supplemented children had a significant improvement in plasma zinc levels and serum alkaline phosphatase by day 14 of therapy in comparison with controls. Plasma copper levels were low in both groups at admission and although an increase was seen in control children, levels decreased further after zinc supplementation. There was no significant difference between the two groups for hemoglobin, serum albumin, prealbumin, and plasma insulin-like growth factor-1 increments during the course of therapy. Evaluation of primary and secondary outcome criteria among the subset of children with plasma zinc levels <60 µg/d at admission did not reveal any significant differences.

Conclusions.  Although there was satisfactory recovery in malnourished children with persistent diarrhea receiving the Khitchri-yogurt diet, there was no evidence of improved weight gain or acceleration of recovery from diarrhea with zinc supplementation. In contrast, the reduction in plasma copper levels in zinc-supplemented malnourished children suggests that caution should be exercised in supplementing severely malnourished children with zinc alone.  Key words:  persistent diarrhea, Khitchri, yogurt, nutritional rehabilitation, zinc, copper.




This article has been cited by other articles:


Home page
 Am. J. Clin. Nutr.Home page
C. L F. Walker, Z. A Bhutta, N. Bhandari, T. Teka, F. Shahid, S. Taneja, R. E Black, and the Zinc Study Group
Zinc during and in convalescence from diarrhea has no demonstrable effect on subsequent morbidity and anthropometric status among infants <6 mo of age
Am. J. Clinical Nutrition, March 1, 2007; 85(3): 887 - 894.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
A. H. Baqui, C. L. F. Walker, K. Zaman, S. E. Arifeen, H. R. Chowdhury, M. A. Wahed, R. E. Black, and L. E. Caulfield
Weekly Iron Supplementation Does Not Block Increases in Serum Zinc Due to Weekly Zinc Supplementation in Bangladeshi Infants
J. Nutr., September 1, 2005; 135(9): 2187 - 2191.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
P. Valentiner-Branth, H. Steinsland, G. Santos, M. Perch, K. Begtrup, M. K Bhan, F. Dias, P. Aaby, H. Sommerfelt, and K. Molbak
Community-based controlled trial of dietary management of children with persistent diarrhea: sustained beneficial effect on ponderal and linear growth
Am. J. Clinical Nutrition, May 1, 2001; 73(5): 968 - 974.
[Abstract] [Full Text] [PDF]