Zinc supplementation reduces duration of diarrheal episodes in infants in developing countries

Diarrheal disease accounts for approximately one-fourth of all deaths among children in developing countries aged 0-4 years, causing an estimated 3 million deaths each year and contributing substantially to malnutrition in surviving children. Bhutta et al.pooled data from a total of 7 treatment trials with supplemental zinc and oral rehydration for diarrhea, including 3 trials in children with acute diarrhea (lasting 14 days before enrollment in the study) and 4 trials in children with persistent diarrhea (lasting * 14 days before enrollment). The 3,086 children, who ranged from 3-36 months in age, lived in developing nations where poor sanitation, overcrowding, contamination of water and inadequate food hygiene are commonplace. In the zinc supplementation trials, the duration of the acute diarrheal episode was reduced by 16% overall. In cases of persistent diarrhea, the zinc-supplemented children had a 24% lower probability of continuance of diarrhea on a given day, and a 42% lower rate of treatment failure or death. The positive effect was especially significant in male children 12 months old who were also malnourished. A 29% overall reduction in duration of diarrhea was evident when all 7 studies were pooled.

Zinc supplementation with oral rehydration therapy is an inexpensive approach which could be helpful in efforts to reduce treatment cost of diarrhea, and it may be perceived by caregivers as a desirable alternative to antibiotics and other drugs. The across-the-board benefits of zinc supplementation suggest that zinc should be provided to all children with acute and persistent diarrhea in settings where it is common. Attention should now be focused on the best means of providing zinc to infants and toddlers during diarrhea and on methods for improving zinc nutriture in developing countries.

Bhutta 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;72:1516-22.

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