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The relationship between zinc intake and growth in children aged 1–8 years: a systematic review and meta-analysis

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Abstract

Background/objectives:

It is estimated that zinc deficiency affects 17% of the world's population, and because of periods of rapid growth children are at an increased risk of deficiency, which may lead to stunting. This paper presents a systematic review and meta-analysis of the randomised controlled trials (RCTs) that assess zinc intake and growth in children aged 1–8 years. This review is part of a larger systematic review by the European Micronutrient Recommendations Aligned Network of Excellence that aims to harmonise the approach to setting micronutrient requirements for optimal health in European populations (www.eurreca.org).

Subject/methods:

Searches were performed of literature published up to and including December 2013 using MEDLINE, Embase and the Cochrane Library databases. Included studies were RCTs in apparently healthy child populations aged from 1 to 8 years that supplied zinc supplements either as capsules or as part of a fortified meal. Pooled meta-analyses were performed when appropriate.

Results:

Nine studies met the inclusion criteria. We found no significant effect of zinc supplementation of between 2 weeks and 12 months duration on weight gain, height for age, weight for age, length for age, weight for height (WHZ) or WHZ scores in children aged 1–8 years.

Conclusions:

Many of the children in the included studies were already stunted and may have been suffering from multiple micronutrient deficiencies, and therefore zinc supplementation alone may have only a limited effect on growth.

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References

  1. Brown KH, Wuehler SE, Peerson JM . The importance of zinc in human nutrition and estimation of the global prevalence of zinc deficiency. Food Nutr Bull 2001; 22: 113–125.

    Article  Google Scholar 

  2. Hotz C, Brown KH . International Zinc Nutrition Consultative Group (IZiNCG). Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull 2004; 25: S94–S203.

    Article  Google Scholar 

  3. Prasad AS . Impact of the discovery of human zinc deficiency on health. J Am Coll Nutr 2009; 28: 257–265.

    Article  CAS  Google Scholar 

  4. Caulfield L, Black R . Zinc Deficiency. In: Ezzati M, Lopez A, Rodgers A, Murray C (eds) Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. World Health Organization: Geneva, Switzerland, 2004; 1, pp 257–280.

    Google Scholar 

  5. Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; 371: 243–260.

    Article  Google Scholar 

  6. Gibson RS . Zinc: the missing link in combating micronutrient malnutrition in developing countries. Proc Nutr Soc 2006; 65: 51–60.

    Article  CAS  Google Scholar 

  7. Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA et al. Childhood Pneumonia and Diarrhoea 1 Global burden of childhood pneumonia and diarrhoea. Lancet 2013; 381: 1405–1416.

    Article  Google Scholar 

  8. Prasad AS . Discovery of human zinc deficiency and studies in an experimental human model. Am J Clin Nutr 1991; 5: 403–412.

    Article  Google Scholar 

  9. Hess SY, Lonnerdal B, Hotz C, Rivera JA, Brown KH . Recent advances in knowledge of zinc nutrition and human health. Food Nutr Bull 2009; 30: S5–S11.

    Article  Google Scholar 

  10. Mozaffair-Khosravi H, Shakiba M, Eftekhari MH, Fatehi F . Effects of zinc supplementation on physical growth in 2-5 year old children. Biol Trace Elem Res 2009; 128: 118–127.

    Article  Google Scholar 

  11. Gibson RS, Hess SY, Hotz C, Brown KH . Indicators of zinc status at the population level: a review of the evidence. Br J Nutr 2008; 99: S14–S23.

    Article  CAS  Google Scholar 

  12. De Onis M, Blossner M, Borghi E . Prevalence and trends of stunting among pre-school children, 1990–2020. Public Health Nutr 2012; 15: 142–148.

    Article  Google Scholar 

  13. Brown KH, Peerson JM, Rivera J, Allen LH . Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2002; 75: 1062–1071.

    Article  CAS  Google Scholar 

  14. Brown KH, Peerson JM, Baker SK, Hess SY . Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull 2009; 30: S12–S40.

    Article  Google Scholar 

  15. Ramakrishnan U, Nguyen P, Martorell R . Effects of micronutrients on growth of children under 5 y of age: meta-analyses of single and multiple nutrient interventions. Am J Clin Nutr 2009; 89: 191–203.

    Article  CAS  Google Scholar 

  16. Imdad A, Bhutta ZA . Effect of preventive zinc supplementation on linear growth in children under 5 years of age in developing countries: a meta-analysis of studies for input to the lives saved tool. BMC Public Health 2011; 11: S22–S35.

    Article  Google Scholar 

  17. Underwood LE . Special considerations in the design of trials involving children. J Nutr 1999; 129: 264S–269S.

    Article  CAS  Google Scholar 

  18. Underwood LE, Van Wyk JJ . Normal and aberrant growth. In: Wilson J, Foster D (eds) Williams Textbook of Endocrinology. WB Saunders: Philadelphia, PA, USA, 1991 pp 1097–1137.

    Google Scholar 

  19. Stettler N, Bhatia J, Parish A, Stallings VA . Feeding healthy infants, children, and adolescents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF (eds) Nelson Textbook of Pediatrics. 19th edn. Saunders Elsevier: Philadelphia, PA, USA, 2011 pp 160–169.

    Chapter  Google Scholar 

  20. Moran VH, Stammers A-L, Medina MW, Patel S, Dykes F, Souverein OW et al. The relationship between zinc intake and serum/plasma zinc concentration in children: a systematic review and dose-response meta-analysis. Nutrients 2012; 4: 841–858.

    Article  CAS  Google Scholar 

  21. Wuehler SE, Sempertegui F, Brown KH . Dose-response trial of prophylactic zinc supplements, with or without copper, in young Ecuadorian children as risk of zinc deficiency. Am J Clin Nutr 2008; 87: 723–733.

    Article  CAS  Google Scholar 

  22. Gibson RS, Vanderkooy PDS, MacDonald AC, Goldman A, Ryan BA, Berry M . A growth-limiting, mild zinc-deficiency syndrome in some Southern Ontario boys with low height percentiles. Am J Clin Nutr 1989; 49: 1266–1273.

    Article  CAS  Google Scholar 

  23. Kikafunda JK, Walker AF, Allan EF, Tumwine JK . Effect of zinc supplementation on growth and body composition of Ugandan preschool children: a randomised, controlled, intervention trial. Am J Clin Nutr 1998; 68: 1261–1266.

    Article  CAS  Google Scholar 

  24. Sempertegui F, Estrella B, Correa E, Aguirre L, Saa B, Torres M et al. Effects of short-term zinc supplementation on cellular immunity, respiratory symptoms, and growth of malnourished Equadorian children. Eur J Clin Nutr 1996; 50: 42–46.

    CAS  PubMed  Google Scholar 

  25. Rahman MM, Tofail F, Wahed MA, Fuchs GJ, Baqui AH, Alvarez JO . Short-term supplementation with zinc and vitamin A has no significant effect on the growth of undernourished Bangladeshi children. Am J Clin Nutr 2002; 75: 87–91.

    Article  CAS  Google Scholar 

  26. Souverein OW, Dullemeijer C, Van ‘T Veer P, Van De Voet H . Transformations of summary statistics as input in meta-analysis for linear dose-response models on a logarithmic scale: A methodology developed within EURRECA. BMC Med Res Methodol 2012; 12: 57.

    Article  Google Scholar 

  27. Higgins JPT, Green S . Cochrane Handbook for Systematic Reviews for Interventions, Version 5.0.2 (updated September 2009). The Cochrane Collaboration: Chichester, UK, 2009.

    Google Scholar 

  28. Walravens PA, Krebs NF, Hambidge KM . Linear growth of low income preschool children receiving a zinc supplement. Am J Clin Nutr 1983; 38: 195–201.

    Article  CAS  Google Scholar 

  29. Silva APR, Vitolo MR, Zara LF, Castro CFS . Effects of zinc supplementation on 1- to 5-year old children. J Pediatr 2006; 82: 227–231.

    CAS  Google Scholar 

  30. Rosado JL, Lopez P, Munoz E, Martinez H, Allen LH . Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican pre-schoolers. Am J Clin Nutr 1997; 65: 13–19.

    Article  CAS  Google Scholar 

  31. Cavan KR, Gibson RS, Grazioso CF, Isalgue AM, Ruz M, Solomons NW . Growth and body composition of periurban Guatemalan children in relation to zinc status: a longitudinal zinc intervention trial. Am J Clin Nutr 1993; 57: 344–352.

    Article  CAS  Google Scholar 

  32. Tran CD, Miller LV, Krebs NF, Lei S, Hambidge KM . Zinc absorption as a function of the dose of zinc sulfate in aqueous solution. Am J Clin Nutr 2004; 80: 1570–1573.

    Article  CAS  Google Scholar 

  33. Hambidge KM, Miller LV, Westcott JE, Sheng X, Krebs NF . Zinc bioavailability and homeostasis. Am J Clin Nutr 2010; 91: 1478S–1483S.

    Article  CAS  Google Scholar 

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Acknowledgements

The work reported herein has been carried out within the EURRECA Network of Excellence (www.eurreca.org), which is financially supported by the Commission of the European Communities, specific Research, Technology and Development Programme Quality of Life and Management of Living Resources, within the Sixth Framework Programme, contract no. 036196. This report does not necessarily reflect the Commission’s views or its future policy in this area. The original conception of the systematic review was undertaken by the EURRECA Network and coordinated by partners based at Wageningen University (WU), the Netherlands and the University of East Anglia (UEA), United Kingdom. Susan Fairweather-Tait (UEA), Lisette de Groot (WU), Pieter van’ t Veer (WU), Kate Ashton (UEA), Amélie Casgrain (UEA), Adriënne Cavelaars (WU), Rachel Collings (UEA), Rosalie Dhonukshe-Rutten (WU), Esmée Doets (WU), Linda Harvey (UEA) and Lee Hooper (UEA) designed and developed the review protocol and search strategy. The authors thank Nick Kenworthy, Sarah Richardson-Owen, Hannah Eichmann, Joseph Saavedra and Christine Cockburn for assistance with data extraction and Olga W Souverein (WU) and Carla Dullemeijer (WU) for calculating the estimated intake-growth regression coefficient (β̂).

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Authors and Affiliations

  1. International Institute of Nutritional Sciences and Food Safety Studies, University of Central Lancashire, Preston, UK

    A-L Stammers, N M Lowe, M W Medina & S Patel

  2. Maternal & Infant Nutrition & Nurture Unit (MAINN), University of Central Lancashire, Preston, UK

    F Dykes & V H Moran

  3. Community Nutrition Unit, Bilbao City Council, Bilbao, Spain

    C Pérez-Rodrigo

  4. Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain

    L Serra-Majam & M Nissensohn

  5. Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN, CB06/03), Instituto de Salud Carlos III, Madrid, Spain

    L Serra-Majam & M Nissensohn

Authors
  1. A-L Stammers
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  2. N M Lowe
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  3. M W Medina
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  4. S Patel
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  5. F Dykes
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  6. C Pérez-Rodrigo
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  7. L Serra-Majam
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  8. M Nissensohn
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  9. V H Moran
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Corresponding author

Correspondence to V H Moran.

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Stammers, AL., Lowe, N., Medina, M. et al. The relationship between zinc intake and growth in children aged 1–8 years: a systematic review and meta-analysis. Eur J Clin Nutr 69, 147–153 (2015). https://doi.org/10.1038/ejcn.2014.204

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