Abstract
BackgroundPrevious trials have shown that zinc supplementation can decrease the risk of diarrhea, pneumonia, and malaria in children; however, the effects of zinc supplementation on mortality remain unclear. This study aimed at evaluating the benefits and risks of zinc supplementation on both total mortality and cause-specific mortality.Methodology and Principal FindingsWe searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials in preschool children reporting total mortality or cause-specific mortality. Relative risk (RR) was used as a measure of the effect of zinc supplementation on the risk of mortality using a random effect model. Of the 1,520 identified articles, we included 8 trials reporting data on 87,854 children. Overall, zinc supplementation had no effect on total mortality (RR, 0.76; 95% CI: 0.56–1.04; P = 0.084), diarrhea-related mortality (RR, 0.80; 95% CI: 0.53–1.20; P = 0.276), pneumonia-related mortality (RR, 0.52; 95% CI: 0.11–2.39; P = 0.399), malaria-related mortality (RR, 0.90; 95% CI: 0.77–1.06; P = 0.196), or other causes of mortality (RR, 0.98; 95% CI: 0.67–1.44; P = 0.917). Subgroup analysis indicated that zinc supplementation was associated with a reduction in total mortality risk if the participants were boys, aged greater than 12 months, and the duration of the follow-up period was less than 12 months.Conclusions/SignificanceZinc supplementation does not have an effect on total mortality, diarrhea-related mortality, pneumonia-related mortality, malaria-related mortality, or other causes of mortality. Subgroup analysis suggested that zinc supplementation can effectively reduce the risk of total mortality if the participants were boys, aged greater than 12 months, and the duration of the follow-up period was less than 12 months.
Highlights
Zinc deficiency is common in children in developing countries due to the low food intake, restricted zinc bioavailability from local diets, and losses of zinc during diarrheal illness [1,2]
Zinc supplementation has a marked effect on the risk of diarrhea, pneumonia, and malaria that has already been described by randomized controlled trials [3,4,5] and metaanalysis [6]
The effect of zinc supplementation in reducing the risk of total mortality has not been confirmed by randomized controlled trials or meta-analysis
Summary
Zinc deficiency is common in children in developing countries due to the low food intake, restricted zinc bioavailability from local diets, and losses of zinc during diarrheal illness [1,2]. Over the past few decades, several studies [3,4] have shown that zinc supplementation had a beneficial impact on the incidence of diarrhea, pneumonia, and malaria and that it can increase weight gain among low-birth weight infants [5]. All of these are considered risk factors for mortality. Subgroup analysis suggested that zinc supplementation can effectively reduce the risk of total mortality if the participants were boys, aged greater than 12 months, and the duration of the follow-up period was less than 12 months
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