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Zinc Update: Positive effect of zinc supplementation in children under 5 years of age

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eMediNexus    13 October 2020

Zinc plays an essential role in cellular differentiation, cellular growth and metabolism. Earlier meta-analyses outcomes assessing the effect of zinc supplementation on linear growth are varying. An updated and evaluated evidence according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria are made available and has also tried to explain the alteration in outcomes of the earlier reviews.

A literature search was performed on Cochrane Library, PubMed, IZiNCG database and WHO regional databases with different terms for zinc and linear growth (height). Information was abstracted in a standardized form and was analysed in two ways such as weighted mean difference and pooled mean difference for total increment in length in centimeters. Random effect models were used for these collective estimates. Recommendations for efficacy of zinc supplementation in the form of absolute increment in length (cm) in zinc supplemented group as compared to control group for input to Live Saves Tool (LiST) were given.

Thirty-six studies evaluating the effect of zinc supplementation on linear growth in children < 5 years from developing countries were available. In eleven studies, zinc was given in combination with other micronutrients (iron, vitamin A, etc). The final result size after pooling all the data sets (zinc ± iron etc) presented a significant positive effect of zinc supplementation on linear growth in the developing countries. A subgroup analysis without those data sets in which zinc was supplemented in combination with iron showed a more distinct effect of zinc supplementation on linear growth.

A subgroup analysis from the studies that had reported actual increase in length (cm) exhibited that a dose of 10 mg zinc/day for 24 weeks resulted in a net gain of 0.37 (± 0.25) cm in the zinc supplemented group as compared to placebo group. This evaluation is recommended for inclusion in Lives Saved Tool (LiST) model.

The meta-analysis concluded that zinc supplementation has a significant beneficial effect on linear growth, particularly when administered alone. It should be included in national strategies to reduce stunting in children < 5 years of age especially in developing countries.

Source: 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 Apr 13;11 Suppl 3(Suppl 3):S22. doi: 10.1186/1471-2458-11-S3-S22. PMID: 21501440; PMCID: PMC3231896.

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