zinc
Place in Therapy
Place in Therapy
Zinc supplementation has been shown to have some weak evidence in reducing the severity and duration of non-infectious diarrhea in children.(3,4) The Cochrane review found that the duration of acute diarrhea may be reduced by 10 hours and 16 hours in persistent diarrhea in children with zinc supplementation.(3) However, there are also conflicting evidence where zinc was not beneficial in well-nourished children and infants between the ages of 1 and 6 months.(1,3) In more recent reviews, zinc appears to be more beneficial in malnourished children experiencing diarrhea than well-nourished children and reduce its duration by about 27 hours.(3,4) One study with well-nourished children did not receive any benefits from zinc supplementation.(3)
However, most primary sources and those included in the reviews were conducted in areas where there is a high risk of zinc deficiency and malnutrition. This questions the applicability of zinc supplementation for other areas such as developed countries where zinc deficiency and malnutrition is less prominent. There was a high level of heterogeneity in the studies given the different populations, types of interventions, settings, inclusion criteria, and definitions used. Most studies were also not powered to determine whether there was a mortality benefit or a reduction in hospitalization with zinc supplementation. Better-designed studies are needed to determine the role of zinc supplementation for children with acute or persistent diarrhea in developed countries, children less than 6 months of age, and whether there was a mortality benefit. Due to the heterogeneity and the question of applicability of zinc supplementation for children with acute or persistent diarrhea, supplementation is considered to be an alternative for parents who wish to use an agent for their child who is a candidate for self-care.
As zinc is a vital micronutrient in healthy growth and development in children, the World Health Organization and UNICEF has recommended the following zinc supplementation: 20mg per day for children over 6 months of age for 10 to 14 days; and 10mg per day for children less than 6 months of age.(5) Zinc supplementation has been found to be well tolerated by children and vomiting has been reported to be the most common adverse effect.(1-4)
References:
(1) Brooks WA, Santosham M, Roy SK, et al. Efficacy of zinc in young infants with acute watery diarrhea. Am J Clin Nutr. 2005;82:605-10.
(2) Patro B, Szymanski H, Szajewska H. Oral zinc for the treatment of acute gastroenteritic in Polish children: a randomized, double-blind, placebo-controlled trial. J Pediatr. 2010;157:984-988.
(3) Lazzerini M, Ronfani L. Oral zinc for treating diarrhea in children. Cochrane Database Syst Rev. 2013;1:CD005436.
(4) Galvao TF, Thees MF, Pontes RF, Silva MT, Pereira MG. Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis. Rev Panam Salud Publica.2013;33:370-7.
(5) Khan WU, Sellen DW. Zinc supplementation in the management of diarrhoea. World Health Organization. April 2011. http://www.who.int/elena/titles/bbc/zinc_diarrhoea/en/. Accessed July 15, 2014.
Zinc supplementation has been shown to have some weak evidence in reducing the severity and duration of non-infectious diarrhea in children.(3,4) The Cochrane review found that the duration of acute diarrhea may be reduced by 10 hours and 16 hours in persistent diarrhea in children with zinc supplementation.(3) However, there are also conflicting evidence where zinc was not beneficial in well-nourished children and infants between the ages of 1 and 6 months.(1,3) In more recent reviews, zinc appears to be more beneficial in malnourished children experiencing diarrhea than well-nourished children and reduce its duration by about 27 hours.(3,4) One study with well-nourished children did not receive any benefits from zinc supplementation.(3)
However, most primary sources and those included in the reviews were conducted in areas where there is a high risk of zinc deficiency and malnutrition. This questions the applicability of zinc supplementation for other areas such as developed countries where zinc deficiency and malnutrition is less prominent. There was a high level of heterogeneity in the studies given the different populations, types of interventions, settings, inclusion criteria, and definitions used. Most studies were also not powered to determine whether there was a mortality benefit or a reduction in hospitalization with zinc supplementation. Better-designed studies are needed to determine the role of zinc supplementation for children with acute or persistent diarrhea in developed countries, children less than 6 months of age, and whether there was a mortality benefit. Due to the heterogeneity and the question of applicability of zinc supplementation for children with acute or persistent diarrhea, supplementation is considered to be an alternative for parents who wish to use an agent for their child who is a candidate for self-care.
As zinc is a vital micronutrient in healthy growth and development in children, the World Health Organization and UNICEF has recommended the following zinc supplementation: 20mg per day for children over 6 months of age for 10 to 14 days; and 10mg per day for children less than 6 months of age.(5) Zinc supplementation has been found to be well tolerated by children and vomiting has been reported to be the most common adverse effect.(1-4)
References:
(1) Brooks WA, Santosham M, Roy SK, et al. Efficacy of zinc in young infants with acute watery diarrhea. Am J Clin Nutr. 2005;82:605-10.
(2) Patro B, Szymanski H, Szajewska H. Oral zinc for the treatment of acute gastroenteritic in Polish children: a randomized, double-blind, placebo-controlled trial. J Pediatr. 2010;157:984-988.
(3) Lazzerini M, Ronfani L. Oral zinc for treating diarrhea in children. Cochrane Database Syst Rev. 2013;1:CD005436.
(4) Galvao TF, Thees MF, Pontes RF, Silva MT, Pereira MG. Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis. Rev Panam Salud Publica.2013;33:370-7.
(5) Khan WU, Sellen DW. Zinc supplementation in the management of diarrhoea. World Health Organization. April 2011. http://www.who.int/elena/titles/bbc/zinc_diarrhoea/en/. Accessed July 15, 2014.