Abstract
ABSTRACTBackgroundEnvironmental enteric dysfunction (EED), a chronic inflammatory disorder of the small bowel, is suspected to impair absorption of micronutrients, including zinc.ObjectiveThe objective of this study was to compare zinc absorption from micronutrient powder (MNP) over a range of zinc doses in young children screened for EED with use of the lactulose:mannitol ratio (L:M).MethodsBangladeshi children aged 18–24 mo, grouped according to high and low L:M (≥0.09 and <0.09, respectively), were randomly assigned to MNP with 0, 5, 10, or 15 mg Zn/sachet (10 subjects per dose per L:M group). Over a day, fractional absorption of zinc was measured from an MNP-fortified meal and from unfortified meals with stable isotope tracers; total daily absorbed zinc (TAZ, milligrams per day) was determined as the primary outcome. Secondary outcomes included investigation of relations of TAZ to intake, to physiologic requirement, and to other variables, including biomarkers of systemic and intestinal inflammation, using nonlinear models. TAZ was also compared with published data on child zinc absorption.ResultsIn 74 subjects who completed the study, zinc absorption did not differ by L:M grouping. Most biomarkers of intestinal inflammation were elevated in both L:M groups. For combined L:M groups, mean ± SD TAZ for each MNP dose (0, 5, 10, and 15 mg/sachet) was 0.57 ± 0.30, 0.68 ± 0.31, 0.90 ± 0.43, and 1.0 ± 0.39 mg/d, respectively (P = 0.002), and exceeded the estimated physiologic requirement only for the 10- and 15-mg MNP doses. Zinc absorption was notably lower at all intake levels compared with published data (P < 0.0001) and was inversely related to serum α-1 acid glycoprotein and to fecal Entamoeba histolytica (P = 0.02).ConclusionResults indicate impaired absorption of zinc, which may predispose to zinc deficiency in young children with evidence of enteropathy. These findings suggest that current doses of zinc in MNP may be insufficient to yield zinc-related preventative benefits in similar settings. This study is registered at clinicaltrials.gov as NCT02758444.
Highlights
Environmental enteric dysfunction (EED) is a disorder of the small bowel which has attracted recent attention as a possible cause of growth faltering, immunity impairment, and micronutrient deficiencies in low-resource settings [1,2,3]
The primary objectives of this study were to measure zinc absorption from micronutrient powder (MNP) with 4 different doses of zinc added to the local foods of Bangladeshi children grouped by urine L:M, as a putative indicator of EED status; to compare the measured zinc absorption between L:M groups as well as to estimated requirements; and to compare absorption results to larger data sets of zinc absorption in children consuming a wide range of zinc intakes [12]
Summary statistics of fractional absorption of zinc (FAZ), TDZ, TAZ, total dietary phytate, phytate:zinc molar ratios, biomarkers of nutritional status, and biomarkers of systemic and intestinal inflammation were calculated for L:M groups and compared with the use of t tests or nonparametric tests when appropriate
Summary
Environmental enteric dysfunction (EED) is a disorder of the small bowel which has attracted recent attention as a possible cause of growth faltering, immunity impairment, and micronutrient deficiencies in low-resource settings [1,2,3]. Environmental enteric dysfunction (EED), a chronic inflammatory disorder of the small bowel, is suspected to impair absorption of micronutrients, including zinc. Objective: The objective of this study was to compare zinc absorption from micronutrient powder (MNP) over a range of zinc doses in young children screened for EED with use of the lactulose:mannitol ratio (L:M). Secondary outcomes included investigation of relations of TAZ to intake, to physiologic requirement, and to other variables, including biomarkers of systemic and intestinal inflammation, using nonlinear models. Conclusion: Results indicate impaired absorption of zinc, which may predispose to zinc deficiency in young children with evidence of enteropathy. These findings suggest that current doses of zinc in MNP may be insufficient to yield zinc-related preventative benefits in similar settings.
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