Short-term zinc prophylaxis decreases infant diarrhea morbidity

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1. Short-term zinc prophylaxis in infants is associated with decreased morbidity from diarrheal episodes. 

2. In those infants receiving zinc supplementation, there was a decrease in incidence and duration of diarrheal episodes, and total number of days suffering from diarrhea during the 5 months following supplementation.

 Evidence Rating Level: 1 (Excellent)

Study Rundown: Deficiency of the mineral cofactor, zinc, is associated with upregulation of intestinal secretory factors. Previous studies of supplementation in children over 1 year of age have indicated that zinc treatment may contribute to reductions in concerning diarrhea-associated morbidity. This community-based randomized control trial, conducted in a migrant population in India, examined short-term prophylactic zinc supplementation in infants 6 – 11 months of age. Prophylactic supplementation for 2 weeks was followed by monitoring of symptoms for 5 months. In comparison to controls, supplemented infants had decreased incidence of diarrhea, reduced diarrheal episode duration, and fewer total days spent suffering from diarrhea. While no serum zinc measurements were taken prior to supplementation, the study population had a high level of stunted growth, which served as a proxy for zinc deficiency. Although this study was limited by its lack of serum zinc measurements, the observed reduction in diarrheal morbidity following short-term supplementation suggests a relatively cost-efficient method to address this significant source of morbidity and mortality worldwide.

Click to read the study published today in Pediatrics

Relevant Reading: Zinc Deficiency, Infectious Disease, and Mortality in the Developing World

Study Author, Akash Malik, MBBS, talks to 2 Minute Medicine: Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals

“This trial is among the first studies where the effect of short course zinc prophylaxis has been exclusively studied in a large sample of normal infants belonging to 6-11 months of age. It showed that short course prophylactic zinc supplementation in normal infants of 6-11 months significantly reduces diarrhea morbidity even after five months of follow up. The results of this study have important cost and operational implications. Short-course prophylaxis of zinc in an adequate dose might be more feasible than continuous therapies if zinc needs to be introduced as a community based prophylactic intervention, which will cover all children. This will reduce the overall incidence of diarrhea in the community compared to administration of zinc only to a small proportion of children who seek treatment. However, further trials are required in similar populations both in developed and developing countries to make available [valid] evidence for policy makers.” 

In-Depth [randomized control trial]: 272 infants, aged 6-11 months, were recruited from a predominantly migrant population in 2 resettlement colonies in India. Serum zinc levels were not measured at baseline, but a previous census of this area suggested high prevalence of zinc deficiency. Each infant was randomly assigned to receive either 20 mg of zinc or placebo suspension orally, every day for 2 weeks. Follow-up took place every other week for 5 months following completion of supplementation. A significant, 39% reduction in incidence of diarrheal episodes was noted in supplemented infants compared to those who received placebo (329 vs. 500; 95% CI 0.53-0.71). Additionally, there was a significant, 36% reduction in duration per episode of diarrhea, with 39% fewer total days in supplemented infants. This double-blinded trial was conducted in 2 phases over a year to eliminate seasonal variations; there were no significant differences between the phases.

By Neha Joshi and Leah H. Carr

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