Zinc Alone Good Enough in Children With Acute Diarrhea

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Results of a randomized controlled trial confirm the benefit of zinc in

children with acute dehydrating diarrhea and suggest no real benefit of

additional supplementation with vitamin A and a combination of

micronutrients.

" We expected to find a better therapeutic effect with combined therapy, "

said Dr. Phalguni Dutta and colleagues from the National Institute of

Cholera and Enteric Diseases in Kolkata, India.

But combined therapy did not have any added advantage over zinc alone,

reported online May 18 in the *Journal of Pediatrics*.

The World Health Organization and United Nations Children's Fund both

recommend zinc supplementation for children with diarrhea. " Despite strong

supportive evidence, it has not yet been globally accepted as a therapeutic

agent, " the investigators note.

They also note that vitamin A deficiency is a major problem in developing

countries, and trials of vitamin A supplementation have shown it can reduce

the severity and duration of diarrhea, and even related mortality.

Deficiencies in copper, iron, folate, vitamin B12 and selenium are also

common in children from developing countries.

Dr. Dutta and colleagues compared the efficacy of zinc, vitamin A and

micronutrient supplementation in 167 children, aged 6 to 24 months, who were

hospitalized at the Dr. B. C. Roy Memorial Hospital for Children in Kolkata,

with acute watery diarrhea and moderate dehydration during March 1999 and

May 2001.

Subjects were randomly assigned to zinc plus placebo (group 1; n = 41), zinc

plus other micronutrients plus vitamin A (group 2; n = 39), zinc plus

vitamin A (group 3; n = 44), or placebo (group 4; n = 43) as an adjunct to

oral rehydration solution.

The daily dose of zinc was 20 mg, twice the Recommended Daily Allowance. The

daily micronutrient combination consisted of zinc (20 mg), iron (10 mg),

copper (2 mg), selenium (40 mg), vitamin B12 (1.4 mg), and folate (100 mg).

Vitamin A was given on admission following national guidelines (age < 1

year, 100,000 IU; age > 1 year, 200,000 IU).

The investigators report that all of the children were successfully managed

with oral rehydration solution; none required intravenous fluid or developed

any complications during the study.

Compared with placebo, children in the three supplemented groups had

significant (P < 0.0001) reductions in the major outcome variables: duration

and volume of diarrhea, and intake of oral rehydration solution.

The percentage of children who recovered within 5 days was 93%, 100%, and

98% for groups 1, 2, and 3, compared with 68% for group 4 (placebo). The

duration of diarrhea after the start of therapy was 64 hours in groups 1 and

2, 59 hours in group 3, and 88 hours in group 4.

The greatest reduction in outcome variables and most rapid recovery were

seen in group 2 (zinc plus micronutrients/vitamin A) and group 3 (zinc plus

vitamin A), respectively, the investigators note, but the differences among

the supplemented groups were not statistically significant.

The difference in cure rate was statistically significant between the

supplemented groups and the placebo group but not among the supplemented

groups.

Limitations of the study include a small sample size, which might have

failed to detect a favorable impact of combined therapy. The failure to

measure zinc levels in the children is another limitation.

Summing up, they say their study supports the use of zinc supplements as

add-on therapy in children with acute diarrhea. They say a well-designed

clinical trial with larger sample sizes is needed to better understand the

beneficial effects of combined therapy with micronutrients and vitamins in

children with diarrhea.

*J Pediatr.* Published online May 18, 2011.

Abstract<http://www.jpeds.com/article/S0022-3476%2811%2900284-8/abstract>

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Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

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