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 Sazawal, S.
Right arrow Articles by Bagati, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sazawal, S.
Right arrow Articles by Bagati, A.
Related Collections
Right arrow Nutrition & Metabolism

PEDIATRICS Vol. 108 No. 6 December 2001, pp. 1280-1286

Zinc Supplementation in Infants Born Small for Gestational Age Reduces Mortality: A Prospective, Randomized, Controlled Trial

Sunil Sazawal, PhD*,{ddagger}, Robert E. Black, MD*, Venugopal P. Menon, PhD{ddagger}, Pratibha Dinghra, MSc{ddagger}, Laura E. Caulfield, PhD*, Usha Dhingra, MA{ddagger} and Adeep Bagati, PhD§

* Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
{ddagger} Center for Micronutrient Research, Annamalai University, Tamil Nadu, India
§ Ranbaxy Research Laboratories, Gurgaon, Haryana, India

Background. Low birth weight infants have been noted to have low zinc concentrations in cord blood, and zinc deficiency in childhood is associated with reduced immunocompetence and increased infectious disease morbidity. This study investigates whether zinc supplementation of infants born full term and small for gestational age affects mortality.

Methods. A randomized, double-blind, controlled trial with 2-by-2 factorial design enrolled 1154 full-term small for gestational age infants to receive in syrup 1 of the following: riboflavin; riboflavin and zinc (5 mg as sulfate); riboflavin, calcium, phosphorus, folate, and iron; or riboflavin, zinc, calcium, phosphorus, folate, and iron. A fixed dosage of 5 mL per child was given daily from 30 to 284 days of age. Household visits were made 6 days per week to provide the syrup and conduct surveillance for illness and death. When a child’s death was reported, parental reports and medical records were used to ascertain the cause. The effects of zinc and of the combination of iron, folate, calcium, and phosphorus were analyzed by intent to treat. The mortality analysis was performed using a survival analytic approach that models time until death as the dependent variable; all models had 2 terms as independent variables: 1 for the zinc effect and 1 for the vitamin and mineral (calcium and phosphorus, folate and iron) effect.

Results. Zinc supplementation was associated with significantly lower mortality, with a rate ratio of 0.32 (95% confidence interval: 0.12–0.89). Calcium, phosphorus, folate, and iron supplementation was not associated with a mortality reduction, although a statistically nonsignificant trend toward reduction was observed with a rate ratio of 0.88 (95% confidence interval: 0.36–2.15).

Conclusion. Zinc supplementation in small for gestational age infants can result in a substantial reduction in infectious disease mortality.

Key Words: zinc • micronutrients • mortality • randomized trial

Abbreviations: LBW, low birth weight • SGA, small for gestational age • WHO, World Health Organization • PI, Ponderal index • RR, rate ratio • CI, confidence interval • RDA, recommended daily allowance

Received for publication Feb 16, 2001; Accepted Jul 24, 2001.




This article has been cited by other articles:


Home page
 Am. J. Clin. Nutr.Home page
S. E Wuehler, F. Sempertegui, and K. H Brown
Dose-response trial of prophylactic zinc supplements, with or without copper, in young Ecuadorian children at risk of zinc deficiency
Am. J. Clinical Nutrition, March 1, 2008; 87(3): 723 - 733.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
S. N Meydani, J. B Barnett, G. E Dallal, B. C Fine, P. F Jacques, L. S Leka, and D. H Hamer
Serum zinc and pneumonia in nursing home elderly
Am. J. Clinical Nutrition, October 1, 2007; 86(4): 1167 - 1173.
[Abstract] [Full Text] [PDF]

Home page
 Int J EpidemiolHome page
P. C Turner, A. C Collinson, Y. B. Cheung, Y. Gong, A. J Hall, A. M Prentice, and C. P Wild
Aflatoxin exposure in utero causes growth faltering in Gambian infants
Int. J. Epidemiol., October 1, 2007; 36(5): 1119 - 1125.
[Abstract] [Full Text] [PDF]

Home page
 NeoReviewsHome page
E. Giles and L. W. Doyle
Zinc in Extremely Low-birthweight or Very Preterm Infants
NeoReviews, April 1, 2007; 8(4): e165 - e172.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
K. M. Hambidge and N. F. Krebs
Zinc Deficiency: A Special Challenge
J. Nutr., April 1, 2007; 137(4): 1101 - 1105.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
B. Lozoff, F. Corapci, M. J. Burden, N. Kaciroti, R. Angulo-Barroso, S. Sazawal, and M. Black
Preschool-Aged Children with Iron Deficiency Anemia Show Altered Affect and Behavior
J. Nutr., March 1, 2007; 137(3): 683 - 689.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
K. H Brown, D. L. de Romana, J. E Arsenault, J. M Peerson, and M. E Penny
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
Am. J. Clinical Nutrition, February 1, 2007; 85(2): 538 - 547.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
N. F Krebs and K M. Hambidge
Complementary feeding: clinically relevant factors affecting timing and composition
Am. J. Clinical Nutrition, February 1, 2007; 85(2): 639S - 645S.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
N. F. Krebs
Food Choices to Meet Nutritional Needs of Breast-fed Infants and Toddlers on Mixed Diets
J. Nutr., February 1, 2007; 137(2): 511S - 517S.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
S. Sazawal, U. Dhingra, P. Dhingra, G. Hiremath, J. Kumar, A. Sarkar, V. P Menon, and R. E Black
Effects of fortified milk on morbidity in young children in north India: community based, randomised, double masked placebo controlled trial
BMJ, January 20, 2007; 334(7585): 140 - 140.
[Abstract] [Full Text] [PDF]

Home page
 NeoReviewsHome page
C. E. P. Trindade
International Perspectives: Microelements and Vitamins in the Nutrition of Very Low-birthweight Preterm Infants: A Brazilian Perspective
NeoReviews, January 1, 2007; 8(1): e3 - e13.
[Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
N. F Krebs, J. L Westcott, D. J Rodden, K. W Ferguson, L. V Miller, and K M. Hambidge
Exchangeable zinc pool size at birth is smaller in small-for-gestational-age than in appropriate-for-gestational-age preterm infants
Am. J. Clinical Nutrition, December 1, 2006; 84(6): 1340 - 1343.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
W A. Brooks, M. Santosham, and R. E Black
Zinc, infectious diseases, and low birth weight.
Am. J. Clinical Nutrition, September 1, 2006; 84(3): 667 - 667.
[Full Text] [PDF]

Home page
 J. Nutr.Home page
K. Kongsbak, M. A. Wahed, H. Friis, and S. H. Thilsted
Acute Phase Protein Levels, T. trichiura, and Maternal Education Are Predictors of Serum Zinc in a Cross-Sectional Study in Bangladeshi Children
J. Nutr., August 1, 2006; 136(8): 2262 - 2268.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
K M. Hambidge
Zinc and pneumonia
Am. J. Clinical Nutrition, May 1, 2006; 83(5): 991 - 992.
[Full Text] [PDF]

Home page
 J. Nutr.Home page
S. L. Kelleher and B. Lonnerdal
Zinc Supplementation Reduces Iron Absorption through Age-Dependent Changes in Small Intestine Iron Transporter Expression in Suckling Rat Pups
J. Nutr., May 1, 2006; 136(5): 1185 - 1191.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
D. L. de Romana, M. Salazar, K M. Hambidge, M. E Penny, J. M Peerson, N. F Krebs, and K. H Brown
Longitudinal measurements of zinc absorption in Peruvian children consuming wheat products fortified with iron only or iron and 1 of 2 amounts of zinc
Am. J. Clinical Nutrition, March 1, 2005; 81(3): 637 - 647.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
L. Allen and R. Shrimpton
The International Research on Infant Supplementation Study: Implications for Programs and Further Research
J. Nutr., March 1, 2005; 135(3): 666S - 669S.
[Full Text] [PDF]

Home page
 BMJHome page
R. Shrimpton, R. Gross, I. Darnton-Hill, and M. Young
Zinc deficiency: what are the most appropriate interventions?
BMJ, February 12, 2005; 330(7487): 347 - 349.
[Full Text] [PDF]

Home page
 PediatricsHome page
Z. A. Bhutta, G. L. Darmstadt, B. S. Hasan, and R. A. Haws
Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence
Pediatrics, February 1, 2005; 115(2/S1): 519 - 617.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
M. M Black, A. H Baqui, K Zaman, L. Ake Persson, S. El Arifeen, K. Le, S. W McNary, M. Parveen, J. D Hamadani, and R. E Black
Iron and zinc supplementation promote motor development and exploratory behavior among Bangladeshi infants
Am. J. Clinical Nutrition, October 1, 2004; 80(4): 903 - 910.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. M. Black, S. Sazawal, R. E. Black, S. Khosla, J. Kumar, and V. Menon
Cognitive and Motor Development Among Small-for-Gestational-Age Infants: Impact of Zinc Supplementation, Birth Weight, and Caregiving Practices
Pediatrics, May 1, 2004; 113(5): 1297 - 1305.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
Z. A Bhutta, I. Gupta, H. de'Silva, D. Manandhar, S. Awasthi, S M M. Hossain, and M A Salam
Maternal and child health: is South Asia ready for change?
BMJ, April 3, 2004; 328(7443): 816 - 819.
[Full Text] [PDF]

Home page
 Int J EpidemiolHome page
K. H Brown
Commentary: Zinc and child growth
Int. J. Epidemiol., December 1, 2003; 32(6): 1103 - 1104.
[Full Text] [PDF]

Home page
 PediatricsHome page
K. M. Hambidge and N. F. Krebs
Zinc, Low Birth Weight, and Breastfeeding
Pediatrics, December 1, 2003; 112(6): 1419 - 1420.
[Full Text] [PDF]

Home page
 J. Nutr.Home page
M. M. Black
Micronutrient Deficiencies and Cognitive Functioning
J. Nutr., November 1, 2003; 133(11): 3927S - 3931.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
F. A. McAlister, S. E. Straus, D. L. Sackett, and D. G. Altman
Analysis and Reporting of Factorial Trials: A Systematic Review
JAMA, May 21, 2003; 289(19): 2545 - 2553.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
M. M. Black
The Evidence Linking Zinc Deficiency with Children's Cognitive and Motor Functioning
J. Nutr., May 1, 2003; 133(5): 1473S - 1476.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
R. E. Black
Zinc Deficiency, Infectious Disease and Mortality in the Developing World
J. Nutr., May 1, 2003; 133(5): 1485S - 1489.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
C. Castillo-Duran and G. Weisstaub
Zinc Supplementation and Growth of the Fetus and Low Birth Weight Infant
J. Nutr., May 1, 2003; 133(5): 1494S - 1497.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
N. M. Diaz-Gomez, E. Domenech, F. Barroso, S. Castells, C. Cortabarria, and A. Jimenez
The Effect of Zinc Supplementation on Linear Growth, Body Composition, and Growth Factors in Preterm Infants
Pediatrics, May 1, 2003; 111(5): 1002 - 1009.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
S. Zlotkin, P. Arthur, C. Schauer, K. Y. Antwi, G. Yeung, and A. Piekarz
Home-Fortification with Iron and Zinc Sprinkles or Iron Sprinkles Alone Successfully Treats Anemia in Infants and Young Children
J. Nutr., April 1, 2003; 133(4): 1075 - 1080.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
S. J. M. Osendarp, C. E. West, and R. E. Black
The Need for Maternal Zinc Supplementation in Developing Countries: An Unresolved Issue
J. Nutr., March 1, 2003; 133(3): 817S - 827.
[Abstract] [Full Text] [PDF]

Home page
 Evid. Based Nurs.Home page
OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02)
Evid. Based Nurs., January 1, 2003; 6(1): e1 - 1.
[Full Text] [PDF]

Home page
 BMJHome page
A. H Baqui, R. E Black, S. E. Arifeen, M. Yunus, J. Chakraborty, S. Ahmed, and J P. Vaughan
Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial
BMJ, November 9, 2002; 325(7372): 1059 - 1059.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
A. Berger
Science commentary: What does zinc do?
BMJ, November 9, 2002; 325(7372): 1062 - 1062.
[Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
R. Martorell
Benefits of zinc supplementation for child growth
Am. J. Clinical Nutrition, June 1, 2002; 75(6): 957 - 958.
[Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
K. H Brown, J. M Peerson, J. Rivera, and L. H Allen
Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: a meta-analysis of randomized controlled trials
Am. J. Clinical Nutrition, June 1, 2002; 75(6): 1062 - 1071.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
N. Bhandari, R. Bahl, S. Taneja, T. Strand, K. Molbak, R. J. Ulvik, H. Sommerfelt, and M. K. Bhan
Substantial Reduction in Severe Diarrheal Morbidity by Daily Zinc Supplementation in Young North Indian Children
Pediatrics, June 1, 2002; 109(6): e86 - 86.
[Abstract] [Full Text] [PDF]