Arch Dis Child 1997;77:196-200 ( September )

Randomised controlled trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhoea

S K Roy,^a A M Tomkins,^b S M Akramuzzaman,^a R H Behrens,^c R Haider,^a D Mahalanabis,^a G Fuchs^a

^a Clinical Sciences Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh, ^b Centre for International Child Health, Institute of Child Health, London, ^c Clinical Nutrition Unit, Department of Clinical Sciences, London School of Hygiene and Tropical Medicine, London

Correspondence to: Dr S K Roy, International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128, Mohakhali, Dhaka 1000, Bangladesh.

Accepted 13 June 1997

OBJECTIVETo evaluate the impact of zinc supplementation on the clinical course, stool weight, duration of diarrhoea, changes in serum zinc, and body weight gain of children with acute diarrhoea.
DESIGNRandomised double blind controlled trial. Children were assigned to receive zinc (20 mg elemental zinc per day) containing multivitamins or control group (zinc-free multivitamins) daily in three divided doses for two weeks.
SETTINGA diarrhoeal disease hospital in Dhaka, Bangladesh.
PATIENTS111 children, 3 to 24 months old, below 76% median weight for age of the National Center for Health Statistics standard with acute diarrhoea. Children with severe infection and/or oedema were excluded.
MAIN OUTCOME MEASURESTotal diarrhoeal stool output, duration of diarrhoea, rate of weight gain, and changes in serum zinc levels after supplementation.
RESULTSStool output was 28% less and duration 14% shorter in the zinc supplemented group than placebo (p = 0.06). There were reductions in median total diarrhoeal stool output among zinc supplemented subjects who were shorter (less than 95% height for age), 239 v 326 g/kg (p < 0.04), and who had a lower initial serum zinc (< 14 mmol/l), 279 v 329 g/kg (p < 0.05); a shortening of mean time to recovery occurred (4.7 v 6.2 days, p < 0.04) in those with lower serum zinc. There was an increase in mean serum zinc in the zinc supplemented group (+2.4 v 0.3 µmol/l, p < 0.001) during two weeks of supplementation, and better mean weight gain (120 v 30 g, p < 0.03) at the time of discharge from hospital.
CONCLUSIONSZinc supplementation is a simple, acceptable, and affordable strategy which should be considered in the management of acute diarrhoea and in prevention of growth faltering in children specially those who are malnourished.

Key messages 20 mg of daily zinc supplementation reduced diarrhoeal stool in shorter children Zinc reduced diarrhoeal stool in those with low serum zinc Zinc reduced duration of diarrhoea in children with low serum zinc Zinc increased body weight of children during acute diarrhoeal episode Malnourished children are likely to benefit more from zinc supplementation

Keywords: zinc supplementation; acute diarrhoea; weight gain; malnutrition

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© 1997 by Archives of Disease in Childhood
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