Zinc (Zn) Absorption from Micronutrient Powders (MNP) Is Low in Bangladeshi Toddlers with Environmental Enteric Dysfunction (EED)

Abstract

ObjectiveEED has been suspected to impair absorption of micronutrients, including Zn, due to the abnormal small bowel mucosa. MNP interventions with 5 mg/sachet have generally not impacted Zn‐associated outcomes. The objective of this study was to compare Zn absorption across a wide range of MNP Zn doses in young children at risk of EED.MethodsBangladeshi children 18–24 mo old, with and without EED (by lactulose:mannitol test) were randomized to MNP with 0, 5, 10, or 15 mg (10 subjects/EED group/dose). Outcomes by EED status included fractional Zn absorption (FAZ) from MNP meal plus from unfortified meals, measured with stable isotopes by urine dual isotope tracer ratio method; total dietary Zn intake (TDZ, mg/d) by duplicate diet collections; and total absorbed Zn (TAZ, mg/d) by FAZ x TDZ. TAZ data were applied to saturation response model (SRM), and to estimated physiologic requirement (EPR, = 0.74 mg/d).ResultsFor the first 49 subjects, combined EED groups, mean (SD) TAZ for each MNP dose was: 0.52 (0.29), 0.72 (0.33), 0.96 (0.48), and 1.07 (0.44), respectively (p=0.006). Absorption followed SRM pattern, but overall curve was lower at all MNP doses than the curve for normal 9 month old breastfed U.S. infants (Figure). Only the mean TAZ for 10 and 15 mg MNP doses exceeded the EPR.ConclusionResults support impaired Zn absorption in young children risk for EED. Final data analysis will determine whether differences are detected between EED and non‐EED conditions. The results suggest a benefit of a Zn dose in MNP of > 5 mg.Support or Funding InformationSponsored by the Bill & Melinda Gates Foundation OPP1113134