Zinc Status In Infants Research Articles

Zinc status in infants and children with cholestatic liver diseases and its effect on growth

Objectives and studyZinc deficiency in children with cholestatic liver diseases could affect growth and immunity. Zinc supplementation is one of the strategies to prevent the consequences of zinc deficiency in children. We aimed to study the effect of zinc supplementation on the growth of these children.MethodsFifty-five infants and children (0.5–10 years) with cholestatic liver diseases enrolled from pediatrics hepatology clinic, Cairo University Hospital: 27 post-Kasai, 7 with Alagille syndrome, and 21 with progressive familial intrahepatic cholestasis. Serum zinc, insulin-like growth factor 1 (IGF-1), and anthropometric measurements are measured at enrollment and 4 months after zinc supplementation and in 30 healthy children with matched age and sex. Serum zinc was measured by atomic absorption spectrometry.ResultsThe mean initial serum zinc (± SD) in cholestatic and healthy control group was 1251 ± 558 and 1461 ± 506 ug/l, respectively (P > 0.05). Meanwhile, serum IGF1 median (IQR; range) in patients and control was 54 (118;10:780) ng/ml and 250 (387;55:635) ng/ml, respectively (p < 0.001). No statistically significant difference was found between post-Kasai patients and other cholestatic diseases. Children supplemented with zinc had their serum zinc 2223 ± 1042 ug/l (P < 0.001) and IGF1 median (IQR; range) 346 (370;50:825) ng/ml (P < 0.001). In addition, among anthropometric variables, height (length) Z-score and percentile were significantly improved (P < 0.01).ConclusionAs compared with the baseline, zinc supplementation had significantly elevated serum zinc levels and IGF1 and improved growth in children with cholestatic liver diseases. Thus, zinc supplementation is beneficial for growth in children with cholestatic liver diseases.

Effect of Socio-Demographic Factors on Zinc Status of Infants and Preschool Children in East Gojjam, Amhara Region of Ethiopia

Effect of Socio-Demographic Factors on Zinc Status of Infants and Preschool Children in East Gojjam, Amhara Region of Ethiopia

Efficacy and safety of new complementary feeding guidelines with an emphasis on red meat consumption: a randomized trial in Bogota, Colombia

Iron deficiency and poor linear growth are common in infants from deprived socioeconomic backgrounds and may be associated with inadequate complementary feeding (CF) practices. We tested the hypothesis that new CF guidelines emphasizing meat as a source of iron and zinc would improve linear growth, iron, and zinc status in infants living in poor socioeconomic circumstances in Bogota, Colombia. A total of 85 term infants who were exclusively breastfed for ≥4 mo were randomly assigned at 6 mo of age to a control group [CG (n = 43); current advice] or intervention group (new guidelines group [NGG (n = 42); with counseling to 1) continue breastfeeding, 2) offer red meat ≥3 d/wk, and 3) offer fruit and vegetables daily]). Main outcomes were 1) linear growth from 6 to 12 mo of age; 2) hemoglobin, hematocrit, iron [serum ferritin (SF)], and zinc status at 12 mo of age; and 3) meat intake at 12 mo of age (by using a food-frequency questionnaire). A total of 38 infants/group provided data at 12 mo of age. NGG infants had significantly higher red meat intake [mean ± SD: 5.4 ± 1.8 compared with 3.5 ± 1.7 d/wk at 12 mo of age; P < 0.001), higher hemoglobin and hematocrit at 12 mo of age, and a significantly greater increase in hemoglobin (mean ± SD change: 0.41 ± 0.8 compared with -0.13 ± 1.0; P = 0.01) and hematocrit (1.04 ± 2.2 compared with -0.15 ± 2.4; P = 0.03) from 6 to 12 mo of age than those in CG infants. There were no significant differences in linear growth from 6 to 12 mo of age or in SF or zinc. The new guidelines showed efficacy with higher red meat intake and positive effects on hemoglobin and hematocrit. The intervention was acceptable and affordable for most mothers. These preliminary results suggest that the intervention merits investigation in a larger cohort with longer-term follow-up. This trial was registered at http://isrctn.org as ISRCTN57733004.

Effect of zinc intake on serum/plasma zinc status in infants: a meta-analysis.

A systematic review and meta-analysis of available randomised controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on serum/plasma Zn status in infants. Out of 5500 studies identified through electronic searches and reference lists, 13 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on serum/plasma Zn concentration was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status and risk of bias. The pooled β of status was 0.09 [confidence interval (CI) 0.05 to 0.12]. However, a substantial heterogeneity was present in the analyses (I(2) = 98%; P = 0.00001). When we performed a meta-regression, the effect of Zn intake on serum/plasma Zn status changed depending on the duration of the intervention, the dose of supplementation and the nutritional situation (P ANCOVA = 0.054; <0.001 and <0.007, respectively). After stratifying the sample according to the effect modifiers, the results by duration of intervention showed a positive effect when Zn intake was provided during medium and long periods of time (4-20 weeks and >20 weeks). A positive effect was also seen when doses ranged from 8.1 to 12 mg day(-1). In all cases, the pooled β showed high evidence of heterogeneity. Zn supplementation increases serum/plasma Zn status in infants, although high evidence of heterogeneity was found. Further standardised research is urgently needed to reach evidence-based conclusions to clarify the role of Zn supplementation upon infant serum/plasma Zn status, particularly in Europe.

A 3‐year longitudinal study of zinc status in infants fed human milk (HM), casein‐based (CBF), or soy‐based formula (SBF) in Korea

Zinc nutritional status was longitudinally assessed by measuring zinc intakes and serum zinc concentrations from birth to 36 months in 51 infants who were exclusively fed HM (n=20), CBF (n=12), or SBF (n=19) during the first 5 months of life. Zinc contents in milk and formulas were measured, and zinc intake was estimated at 1–36 months of life by weighing infants before and after feeding in the HM group and by collecting formula intake records in the CBF and SBF groups. After solid foods were introduced, all foods consumed were also included to estimate zinc intake. Mean daily zinc intakes were 1.0, 3.8, and 7.0 mg at 5 months and 3.8, 5.8 and 11.6 mg at 12 months and 5.5, 3.7, and 6.0 mg at 36 months in the HM, CBF, and SBF groups, respectively. Although the overall zinc intake in infants fed SBF was higher than those in the HM or CBF groups throughout the study, mean serum zinc concentrations were similar in all groups. The proportions of infants with low serum zinc (&lt; 65 μg/100 mL) were 10%, 17%, and 20% at 5 months, and 42%, 30%, and 12% at 12 months, and 33%, 13%, and 20% at 36 months in the HM, CBF, and SBF groups, respectively, suggesting the presence of inadequate zinc status. The strategies to increase zinc intake in the HM group and to increase bioavailability of zinc in CBF or SBF should be studied. Research Support: Dr. Chung's Food Co.

Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants

To evaluate the effect of combined iron-zinc supplementation on micronutrient status, growth and morbidity. Randomized, double-masked, placebo-controlled supplementation trial. Rural district of Que Vo, in the Red River Delta in Vietnam. A total of 915 breast-fed infants aged 4-7 months were included and 784 completed the study. The Fe-group received daily and for a 6-month period 10 mg of iron, the Zn-group 10 mg zinc, the Fe-Zn group 10 mg iron+10 mg zinc and the placebo group a placebo. Hemoglobin (Hb), serum ferritin (SF) and zinc (SZn), and anthropometry were measured before and at the end of the intervention. Morbidity was recorded daily. Changes of Hb and SF were higher in both Fe and Fe+Zn groups (respectively 22.6 and 20.6 g/l for Hb; 36.0 and 24.8 microg/l for SF) compared to Zn and placebo groups (Hb: 6.4 and 9.8 g/l; SF: -18.2 and -16.9 microg/l, P<0.0001). SZn increased more in Zn group (10.3 micromol/l) than in Fe+Zn group (8.0 micromol/l, P=0.03) and more in these groups compared to Fe and placebo groups (1.6 and 1.2 micromol/l, P<0.0001). Weight gain was higher in the Zn group. No significant effects of supplementations on growth in length or morbidity. Combined iron-zinc supplementation had a positive effect on iron and zinc status in infants. However, the positive effect of zinc alone on SZn and weight would indicate a negative interaction of iron when added to zinc supplements. UNICEF New York.

Effects of weaning cereals with different phytate contents on hemoglobin, iron stores, and serum zinc: a randomized intervention in infants from 6 to 12 mo of age

Weaning foods frequently contain phytate, an inhibitor of iron and zinc absorption, which may contribute to the high prevalence of iron and zinc deficiency seen in infancy. The objective was to investigate whether either an extensive reduction in the phytate content of infant cereals or the use of milk-based, iron-fortified infant formula would improve iron and zinc status in infants. In a double-blind design, infants (n = 300) were randomly assigned to 3 cereal groups from 6 to 12 mo of age: commercial milk-based cereal drink (MCD) and porridge (CC group), phytate-reduced MCD and phytate-reduced porridge (PR group), or milk-based infant formula and porridge with the usual phytate content (IF group). Venous blood samples were collected at 6 and 12 mo. Dietary intake was recorded monthly. After the intervention, 267 infants remained in the analysis. Hemoglobin concentrations of < 110 g/L, serum ferritin concentrations of < 12 microg/L, and serum zinc concentrations of < 10.7 micromol/L had overall prevalences at baseline and 12 mo of 28% and 15%, 9% and 18%, and 22% and 27%, respectively. After the intervention, there were no significant differences in any measure of iron or zinc status between the CC and the PR groups. However, hemoglobin was significantly higher (120 g/L compared with 117 g/L; P = 0.012) and the prevalence of anemia was lower (13% compared with 23%; P = 0.06) in the PR group than in the IF group, which could be explained by differences in daily iron intake between the 2 groups. Extensive reduction in the phytate content of weaning cereals had little long-term effect on the iron and zinc status of Swedish infants.

Effect of Timing of Introduction of Complementary Foods on Iron and Zinc Status of Formula Fed Infants at 12, 24, and 36 Months of Age

Objective The timing of introduction of complementary food to an infant’s diet is variable throughout the world. Our objective was to determine whether early introduction of complementary foods affects iron and zinc status of formula-fed infants at 12, 24, and 36 months of age.Design A randomized, prospective trial was conducted. Infants were randomly assigned to receive either a) early introduction (at 3 to 4 months of age) of commercially prepared or parent’s choice of complementary foods; or b) late introduction (at 6 months of age) of commercially prepared complementary foods or parent’s choice of complementary foods. In addition to complementary foods, infants were fed commercial infant formula as recommended by their pediatrician. Hemoglobin, mean corpuscular volume, and serum ferritin and zinc concentrations were determined at 12, 24, and 36 months of age. Three-day diet diaries were completed at 3, 6, 12, 18, 24, 30, and 36 months of age.Subjects/setting One hundred seventy-five infants younger than 3 months were recruited by mailings to parents in the Cincinnati area. Of these, 172 were enrolled, 90 in the early introduction group and 82 in the late-introduction group. One hundred thirty-three infants (n=67 in the early, n=66 in the late group) completed the study.Statistical analyses performed Student t test and regression analyses were used to determine whether there were group differences and whether there was a relationship between serum parameters and dietary intake.Results Infants fed complementary foods early had significantly greater iron intakes until 6 months of age; however, there were no differences in the iron status parameters (ferritin, hemoglobin, and mean corpuscular volume) at 12, 24, or 36 months of age. The early introduction group consumed slightly less zinc than the late introduction group at 5 months (4.4 vs 4.8mg/day, P<.01) and 6 months (4.4 vs 4.7mg/day, P<.01). At all other times there were no differences between the early and late group in zinc intakes. The serum zinc concentration was not associated with dietary zinc. Both groups had normal serum zinc concentrations at 12, 24, and 36 months and there were no differences between groups.Applications/conclusions The iron and zinc status of infants in this study was not influenced by the timing or type of complementary foods introduced. However, the infants were formula fed and the mean iron and zinc intakes that were equal or greater than the Recommended Dietary Allowances for the first 6 months of age. J Am Diet Assoc. 2001;101:443–447.

The use of serum alkaline phosphatase as a predictor of zinc status in infants and children

The use of serum alkaline phosphatase as a predictor of zinc status in infants and children

Plasma and Urine Zinc in Infants and Children with Extrahepatic Biliary Atresia

SummaryThe objective of this study was to undertake a pilot assessment of zinc status in infants and children with extrahepatic biliary atresia. Plasma zinc concentrations and urine zinc excretion rates were measured longitudinally in 45 infants and young children with this disorder. The mean (‐ SD) plasma zinc (298 observations) was 56.8 ‐ 17.9 μg dl (controls 85.6 ‐ 10.8). Plasma zinc was not correlated with age and did not appear to he related to repeated surgical procedures or to episodes of cholangitis. Plasma zinc was only weakly correlated with serum albumin (r ‐ 0.27, p ‐ 0.001). The 24‐h urine zinc excretion rates were correlated with age but not so strongly as for normal children. Hyperzincuria was evident from the linear regression equation of 24‐h urine zinc on age. On a body weight basis, urine zinc excretion rates were 6 times normal for the first 2 years and remained high across the entire age range, to replace these losses, net zinc absorption would need to increase by 40%. The relationship of these data to the zinc nutritional status of these patients and to their underlying hepatic disease remains to be clarified by more definitive studies.

Plasma and urine zinc in infants and children with extrahepatic biliary atresia.

The objective of this study was to undertake a pilot assessment of zinc status in infants and children with extrahepatic biliary atresia. Plasma zinc concentrations and urine zinc excretion rates were measured longitudinally in 45 infants and young children with this disorder. The mean (+/- SD) plasma zinc (298 observations) was 56.8 +/- 17.9 micrograms/dl (controls 85.6 +/- 10.8). Plasma zinc was not correlated with age and did not appear to be related to repeated surgical procedures or to episodes of cholangitis. Plasma zinc was only weakly correlated with serum albumin (r = 0.27, p less than 0.001). The 24-h urine zinc excretion rates were correlated with age but not so strongly as for normal children. Hyperzincuria was evident from the linear regression equation of 24-h urine zinc on age. On a body weight basis, urine zinc excretion rates were approximately 6 times normal for the first 2 years and remained high across the entire age range. To replace these losses, net zinc absorption would need to increase by 40%. The relationship of these data to the zinc nutritional status of these patients and to their underlying hepatic disease remains to be clarified by more definitive studies.

Zinc status of infants with fetal alcohol syndrome.

Plasma and urinary zinc levels were examined in 6 infants with fetal alcohol syndrome to determine whether zinc deficiency, if present in fetal alcohol syndrome patients, is secondary to an increased urinary zinc excretion. Six infants born to nonalcoholic mothers served as controls. There was no significant difference in creatinine clearance, urine flow rate, or plasma albumin concentrations between the two groups. Plasma concentrations of zinc were significantly lower in fetal alcohol syndrome patients (62.5 +/- 2.8 micrograms/dl) in comparison to controls (71 +/- 1.8 microgram/dl), (p = 0.0001). Urinary excretion of zinc in fetal alcohol syndrome patients averaged 646 +/- 125 micrograms/24 h, significantly higher than in control subjects (76.6 +/- 22 micrograms/24 h), (p = 0.0001). Thus (1) lower plasma zinc levels are present in infants with fetal alcohol syndrome and (2) increased urinary zinc excretion appears to be responsible for decreased plasma zinc concentrations.

Serum alkaline phosphatase and zinc undernutrition in infants with chronic diarrhea

III infants and children need zinc replacement in total parenteral nutrition solutions, but assessment of these needs and total body zinc status is difficult. Seven infants with severe diarrhea initially given 80 to 100 micrograms/kg/day of elemental zinc developed systemic zinc deficiency as indicated by an acrodermatitis-like skin rash and low serum alkaline phosphatase. Serum zinc levels were borderline low only in conjunction with hypoalbuminemia. Daily urinary zinc excretion was normal. With increased zinc supplementation of 200 to 300 micrograms/kg/day, the rash healed and serum alkaline phosphatase rose to normal levels for age. The activity of the metalloenzyme alkaline phosphatase accurately reflects total body zinc status in infants. With diarrheal illness, infants, need high doses zinc supplementation to replace considerable stool losses.