DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20173780

Role of zinc supplementation in acute respiratory tract infections in children aged 2 to 60 months

Bindu T. Nair, Rabindra Bhunia, Kuldeep Kumar Sharma

Abstract


Background: Zinc has a major role in improving immune function and decreasing morbidity in various infectious diseases like acute respiratory tract infections, diarrhoeal diseases etc. The objective of the study was to study the effect of zinc supplementation on clinical manifestations, progress of illness and duration of acute respiratory infections.

Methods: A randomized double blind controlled study was conducted in the Paediatric ward of a tertiary care hospital in New Delhi in 50 children aged 2 to 60 months. Children with previous episodes of wheezing, severe malnutrition, congenital heart diseases, pneumonia, history of taking multiple micronutrient formulations or zinc for any intercurrent illnesses like diarrhoea in the previous month prior to admission and history of any known immuno-deficiency disease or on any immunosuppressive medications(steroids) or anti malignancy treatment were excluded. Both placebo (syrup base) and zinc syrup (20 mg/5 mL elemental zinc as zinc sulfate) were given orally for a period of 14 days to the respective groups. Statistical analysis used: Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.). Chi-square test was done for qualitative variables and t-test was used for quantitative variables. P<0.05 was considered as statistically significant.

Results: The mean age of zinc group was 22.77 months (SD - 5.74) and that of placebo group was 22.86 months (SD - 5.88) with a p value of 0.98 which was not statistically significant. There were no significant differences in the clinical features in the two groups before starting therapy or after treatment at 24, 48 and 72 hours (P>0.05).

Conclusions: Zinc supplementation during episode of ARI did not show any substantial benefit in reducing duration or morbidity in children aged 2-60 months. 


Keywords


Acute lower respiratory tract infections, Children, Cyanosis, Tachypnea, Zinc syrup

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References


Roth DE, Caulfield LE, Ezzati M, Black RE. Acute lower respiratory infections in childhood: opportunities for reducing the global burden through nutritional interventions. Bull World Health Organ. 2008;86:356-64.

Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr. 1998;68:447S-63S.

Prasad AS. Discovery of human zinc deficiency and studies in an experimental human model. Am J Clin Nutr. 1991;53(2):403-12.

Caulfield L, Black RE. Zinc deficiency. In Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization, CJL; 2004.

Gibson RS, Ferguson EL. Assessment of dietary zinc in a population. Am J Clin Nutr. 1998;68(2 Suppl):430S-4S.

Chakravarty I, Sinha RK. Prevalence of micronutrient deficiency based on results obtained from the national pilot program on control of micronutrient malnutrition. Nutr Rev. 2002;60(5.2):S53-8.

Bhutta Z, Black R, Brown K. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. J Pediatr. 1999;135:689-97.

Rahman MM, Vermund SH, Wahed MA, Fuchs GJ, Baqui AH, Alvarez JO. Simultaneous zinc and vitamin A supplementation in Bangladeshi children: randomized double blind controlled trial. BMJ. 2001;323:314-8.

Nield LS, Kamat D. Fever. In: Kliegman RM, editor. Nelson’s textbook of Pediatrics, 20th ed. Philadelphia, PA: Chapter177:Elsevier; 2016;1:1277.

Kuppuswamy B. Manual of Socioeconomic Status (Urban), Manasayan, Delhi; 1981.

World Health Organization. Child growth standards. Weight-for-age. Available from: www.who.int/ childgrowth/standards/weight_for_age/en/index.html.

World Health Organization. Child growth standards. Height-for-age. Available at: http://www.who.int/ childgrowth/standards/height_for_age/en/index.htm.

Brown KH, Rivera JA, Bhutta Z, Gibson RS, King JC, Lönnerdal B, et al. International Zinc Nutrition Consultative Group (IZiNCG) Technical Document no. 1. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutri Bull. 2004;25:S94-S203.

Roth DE, Caulfield LE, Ezzati M, Black RE. Acute lower respiratory infections in childhood: opportunities for reducing the global health burden through nutritional interventions. Bulletin of the World Health Organization. 2008;86:356-64.

Doherty CP, Sarkar MA, Shakur MS, Ling SC, Elton RA, Cutting WA. Zinc and rehabilitation from severe protein-energy malnutrition: Higher dose regimens are associated with increased mortality. Am J Clinical Nutri. 1998;68:742-8.

Gibson RS, Bailey KB, Parnell WR, Wilson N, Ferguson EL. Higher risk of zinc deficiency in New Zealand Pacific school children compared with their Māori and European counterparts: A New Zealand national survey. B J Nutri. 2011;105(3):436-46.

Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003;362:65-71.

Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371:417-40.

Lassi ZS, Haider BA, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database System Rev. 2010;(12):CD005978.

Roth DE, Richard SA, Black RE. Zinc supplementation for the prevention of acute lower respiratory infection in children in developing countries: meta-analysis and meta-regression of randomized trials. Internat J Epidemiol. 2010;39(3):795-808.

Bao S, Knoell DL. Zinc modulates airway epithelium susceptibility to death receptor-mediated apoptosis. Am J Physiol Lung Cell Mol Physiol. 2006;290:L433–41.

Castillo-Duran C, Heresi G, Fisberg M, Uauy R. Controlled trial of zinc supplementation during recovery from malnutrition: effects on growth and immune function. Am J Clin Nutr. 1987;45:602-8.

Raqib R, Roy SK, Rahman MJ. Effect of zinc supplementation on immune and inflammatory responses in pediatric patients with shigellosis. Am J Clin Nutr. 2004;79:444-50.

Baqui AH, Zaman K, Persson LA. Simultaneous weekly supplementation of iron and zinc is associated with lower morbidity due to diarrhea and acute lower respiratory infection in Bangladeshi infants. J Nutr. 2003;133:4150-7.

Bhandari N, Bahl R, Taneja S. Effect of routine zinc supplementation on pneumonia in children aged 6 months to 3 years: randomized controlled trial in an urban slum. Br Med J. 2002;324:1358-62.

Shann F, Barker J, Poore P. Clinical signs that predict death in children with severe pneumonia. Pediatr Infect Dis J. 1989;8:852-5.

Demers AM, Morency P, Mberyo-Yaah F. Risk factors for mortality among children hospitalized because of acute respiratory infections in Bangui, Central African Republic. Pediatr Infect Dis J. 2000;19:424-32.

Howie S, Zaman SM, Omoruyi O, Adegbola R, Prentice A. Severe pneumonia research and the problem of case definition: the example of zinc trials. Am J Clin Nutr. 2007;85:242-3.