Elsevier

The Journal of Pediatrics

Volume 207, April 2019, Pages 80-89.e2
The Journal of Pediatrics

Original Articles
Effects of Daily Zinc, Daily Multiple Micronutrient Powder, or Therapeutic Zinc Supplementation for Diarrhea Prevention on Physical Growth, Anemia, and Micronutrient Status in Rural Laotian Children: A Randomized Controlled Trial

https://doi.org/10.1016/j.jpeds.2018.11.022Get rights and content
Under a Creative Commons license
open access

Objectives

To evaluate the optimal zinc supplementation strategy for improving growth and hematologic and micronutrient status in young Laotian children.

Study design

In total, 3407 children aged 6-23 months were randomized to receive either daily preventive zinc tablets (7 mg/d), high-zinc, low-iron micronutrient powder (10 mg/d zinc, 6 mg/d iron, and 13 other micronutrients), therapeutic zinc supplementation for diarrhea (20 mg/d for 10 days per episode), or daily placebo powder; all were followed for ~9 months. Anthropometry, hemoglobin, zinc, and iron status were assessed at baseline and endline. Analyses were by intention-to-treat, using linear and modified Poisson regression.

Results

At baseline, mean (±SD) age was 14.2 ± 5.1 months and stunting and anemia prevalence were 37.9% and 55.6%, respectively. At endline, zinc deficiency in the preventive zinc (50.7%) and micronutrient powder (59.1%) groups were significantly lower than in the therapeutic zinc (79.2%) and control groups (78.6%; P < .001), with no impact on stunting (37.1%-41.3% across the groups, P = .37). The micronutrient powder reduced iron deficiency by 44%-55% compared with other groups (P < .001), with no overall impact on anemia (P = .14). Micronutrient powder tended to reduce anemia by 11%-16% among children who were anemic at baseline (P = .06).

Conclusions

Despite improving zinc status, preventive zinc and micronutrient powder had no impact on growth. The micronutrient powder improved iron status and tended to reduce anemia among the subset of previously anemic children.

Trial registration

ClinicalTrials.gov NCT02428647.

Abbreviations

AGP
Alpha-1-glycoacid protein
CRP
C-reactive protein
LAZ
Length and length-for-age z scores
MUAC
Mid-upper arm circumference
ORS
Oral rehydration salts
RBP
Retinol binding protein
sTfR
Soluble transferrin receptor
WAZ
Weight and weight-for-age z scores
WHO
World Health Organization
WLZ
Weight-for-length z scores

Cited by (0)

Supported by the Mathile Institute for the Advancement of Human Nutrition and Nutrition International (formerly the Micronutrient Initiative) (10-1347-UCALIF-07). Other aspects of the Lao Zinc Study were supported by the Bill & Melinda Gates Foundation (OPP1134272). K.B. and the spouse of S.H. work for the Bill & Melinda Gates Foundation, which provided part of the financial support. The sponsors had no involvement in the field implementation, data analyses, and manuscript writing. S.H. worked as a consultant for the Bill & Melinda Gates Foundation. The other authors declare no conflicts of interest.

Portions of this study were presented at the American Society for Nutrition Conference, June 12, 2018, Boston, Massachusetts, and at the International Congress on Nutrition, October 17, 2017, Buenos Aires, Argentina.