Zinc has often been hailed as a wonder element because of the significant
beneficial effects it accords in improving diarrhea related outcomes after
supplementation for 10-14 days(1). However, most of the studies have been
conducted in children older than 6 months of age(1,2). In children younger
than the age of 6 months, few studies have shown that zinc supplementation
is not consistently associated with significant benefit for diarrhea
related outcomes. Longer term results have also failed to show pronounced
effects of zinc on improvement of general anthropometric status(3,4).
We feel that zinc as an intervention for diarrhea in
children younger than 6 months of age should not be dismissed altogether
or out rightly since decisive consensus must be based on larger scale
clinical trials and observation of consistency in the trends of the result
obtained. Although the few studies conducted so far have provided
interesting results, incorporation of some points in the study design of
future trials can be helpful.
Baseline health status, zinc levels, along with
stratification for exclusive breast feeding status are some of the
parameters that should be considered in future studies of zinc therapy
conducted in children less than 6 months of age. These points also happen
to be the limitations in some of the current studies(4).
We think that a sizeable proportion of pediatric
patients with diarrhea seen in clinical practice are less than 6 months of
age. This calls for larger scale trials of zinc therapy to fully establish
its role and evaluate its effectiveness so as to fully ascertain the need
to prescribe zinc in this pediatric subgroup. In the meantime, we advocate
use of clinical acumen and demonstration of perspicacity on the part of
physicians in weighing the pros and cons of this intervention while
prescribing zinc supplementation to infants less than 6 months of age.
This approach should be exercised because of the paradoxically increased
prevalence of diarrhea in zinc supplemented infants less than 6 months of
age reported in one study(4).
1. Bhutta ZA, Bird SM, Black RE, Brown KH, Gardner JM,
Hidayat A, et al. Therapeutic effects of oral zinc in acute and
persistent diarrhea in children in developing countries: pooled analysis
of randomized controlled trials. Am J Clin Nutr 2000; 72: 1516 –1522.
2. Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S,
Hidayat A, et al. Prevention of diarrhea and pneumonia by zinc
supplementation in children in developing countries: pooled analysis of
randomized controlled trials. J Pediatr 1999: 135: 689-697.
3. Fischer Walker CL, Bhutta ZA, Bhandari N, Teka T,
Shahid F, Taneja S, et al. Zinc supplementation for the treatment
of diarrhea in infants in India, Pakistan, and Ethiopia. J Pediatr
Gastroenterol Nutr 2006; 43: 357– 363.
4. Walker CL, Bhutta ZA, Bhandari N, Teka T, Shahid F,
Taneja S, et al. Zinc during and in convalescence from diarrhea has
no demonstrable effect on subsequent morbidity and anthropometric status
among infants <6 mo of age. Am J Clin Nutr 2007; 85: 887-894.