Journal Article

Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa

Luabeya, K-K.A, Chhagan, M.K, Van den Broeck, J, Mpontshane, N, Bennish, M.L, Tucker, K.L

2009

Overview

Background/Objective: The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children. Potential modifying factors, such as stunting, need to be addressed. The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence, and whether this differs between the strata of stunted or HIV-infected children. Methods: We analyzed data from a randomized, controlled, double-blinded trial (ClinicalTrials.gov NCT00156832) of prophylactic micronutrient supplementation to children aged 6-24 months. Three cohorts of children: 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers, received vitamin A, vitamin A plus zinc or multiple micronutrients, which included vitamin A and zinc. The main outcome was incidence of diarrhoea. Poisson regression was used in intent-to-treat analyses. Stratified analyses followed testing for statistical interaction between intervention and stunting. Results: We observed no significant differences in overall diarrhoea incidence among treatment arms. Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone (2.04 and 2.23 vs 3.92 episodes/year, respectively, P=0.024). No meaningful subgroup analyses could be done in the cohort of HIV-infected children. Conclusions: Compared with vitamin A alone, supplementation with zinc and with zinc and multiple micronutrients, reduced diarrhoea morbidity in stunted rural South African children. Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: administration & dosage / adverse effects / Biological and medical sciences / Care and treatment / child nutrition / Children / Children & youth / Clinical Nutrition / Cohort Studies / complications / Diarrhea / Diarrhea, Infantile / Diarrhea, Infantile - epidemiology / Diarrhea, Infantile - prevention & control / Dietary minerals / Dietary Supplements / disease incidence / Double-Blind Method / Epidemiology / Feeding. Feeding behavior / Ferrous Compounds / Ferrous Compounds - administration & dosage / Ferrous Compounds - therapeutic use / Fundamental and applied biological sciences. Psychology / Gluconates / Gluconates - therapeutic use / Growth Disorders / Growth Disorders - complications / growth retardation / Health aspects / HIV / HIV infections / HIV Infections - complications / human diseases / Human immunodeficiency virus / Humans / Incidence / Infant / Internal Medicine / Iron / Iron - administration & dosage / Iron - adverse effects / Iron - therapeutic use / Malnutrition in children / Medical sciences / Medicine / Medicine & Public Health / Metabolic Diseases / Micronutrients / Micronutrients - adverse effects / Micronutrients - therapeutic use / Morbidity / mothers / Nutrition Disorders / Nutrition Disorders - prevention & control / Nutrition research / nutritional intervention / original-article / prevention & control / Public Health / randomized clinical trials / Retinene / Rural Population / South Africa / Statistical analysis / Subgroups / Supplements / therapeutic use / Vertebrates: anatomy and physiology, studies on body, several organs or systems / Vitamin A / Vitamin A - administration & dosage / Vitamin A - therapeutic use / vitamin-mineral supplements / Zinc / Zinc - administration & dosage / Zinc - adverse effects / Zinc - therapeutic use