News Release

Zinc supplementation does not significantly affect child mortality in Nepal

Peer-Reviewed Publication

The Lancet_DELETED

Zinc supplementation in zinc-deficient children in Nepal has no significant effect on their overall mortality. However, in children in the 12-35 months age group category, there was found to be a small, but non-statistically significant benefit. These are the conclusions of authors of an Article published in this week’s edition of The Lancet.

The WHO Global Burden of disease project estimates that malnutrition, which includes micronutrient deficiencies, is the leading risk factor for child-mortality in low-income and middle-income countries. Zinc deficiency is one of the most common micronutrient deficiencies in children under the age of five years in developing countries.

Professor James Tielsch, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and colleagues did a study of over 40,000 children aged 1-35 months in Nepal, of which around half were given zinc supplementation of 10mg daily while the other half were given placebo. The children were followed up for at least one year, with mortality the primary outcome studied in the trial. Since Zinc deficiency is associated with diarrhoea and acute respiratory infections, signs of these were also monitored in the trial.

The researchers found no significant differences in mortality rates between the two groups as a whole, or in children aged under 12-months in the two groups. While mortality was 20% lower in children aged older than 12 months in the zinc group compared with placebo, this was not regarded as statistically significant. The frequency and duration of diarrhoea, persistent diarrhoea, dysentery, and acute lower respiratory functions did not differ between the groups.

However, the authors say that children with specific histories of morbidity or malnutrition might benefit form zinc supplementation. They add that, when combined with previous studies (meta-analysis), their study does show zinc supplementation has a protective effect in children aged 12 months or older.

They conclude: “However, whether improvements in population zinc status via universal routine supplementation are feasible remains to be shown. Further research on the optimum dose for reduction in morbid outcomes in various settings is needed before large-scale implementation of universal supplementation programmes is justified.”

In an accompanying Comment, Dr Marzia Lazzerini, Institute of Child Health, IRCCS Burlo Garofolo, Trieste, Italy says: “Zinc supplementation seems to have the potential to be an important intervention for the reduction of child mortality in low-income countries…additional evidence is needed if we want to clarify the real size of the effect, especially in regions without malaria, and to decide whether to supplement all children or those at high-risk only.”

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Full contacts

Professor James Tielsch, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA T) +1 410 955-2436 / +1 410 925-1972 E) jtielsch@jhsph.edu
Dr Marzia Lazzerini, Institute of Child Health, IRCCS Burlo Garofolo, Trieste, Italy T) + 39 040 3785 333 / 373 E) lazzerini@burlo.trieste.it

The paper can be viewed at the link below:
http://multimedia.thelancet.com/pdf/press/Zinc.pdf


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