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Zinc Supplementation Reduces the Incidence of Persistent Diarrhea and Dysentery among Low Socioeconomic Children in India^1,2,

Sunil Sazawal^*,,, Robert E. Black^,3, Maharaj K. Bhan^*, Sanju Jalla^*, Nita Bhandari^*, Anju Sinha^* and Sharmila Majumdar^*

^* ICMR Advanced Center for Diarrheal Disease Research, Division of Pediatric Gastroenterology, All India Institute of Medical Sciences, New Delhi, India Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD

Persistent diarrhea (PD) and dysentery (DD) account for most diarrhea-associated deaths among children in developing countries. Zinc deficiency can cause stunting and impaired immune function, both of which are risk factors for these diarrheal illnesses. We investigated the effect of zinc supplementation on the incidence of PD and DD in a community-based, double-blind randomized trial in children 6–35 mo of age. Increase over baseline in plasma zinc concentrations in the supplemented group compared with a control group (3.61 vs. 0.009 µmol·L^-1) indicated successful supplementation. The overall reductions in the zinc supplemented group of 21% in the incidence of PD (95% CI -6 to 42%) and 14% in the incidence of dysentery (95%CI -15 to 36%) were not significant. There was a significant interaction of treatment effect with baseline plasma zinc concentration and age for PD and with gender for DD. In the zinc-supplemented group compared with the control group, the incidence of PD was reduced by 73% (P < 0.05; 95% CI 34 to 91%) in children with a baseline zinc <7.65 µmol·L^-1 and by 49% (P < 0.05; 95%CI 24 to 66%) in children > 11 mo of age. Zinc supplementation resulted in a 38% (P < 0.05 95%CI 8 to 59%) reduction in the incidence of DD in boys. There was no effect on PD among children 6–11 mo old or on DD in girls. In conclusion, zinc supplementation had a significant impact on the incidence of persistent diarrhea in children > 1 y old and in children with low plasma zinc, as well as on dysentery in boys. These findings may have important implications for reducing diarrhea-related morbidity and mortality.

KEY WORDS: • diarrhea • diarrhea infantile • dysentery • zinc • humans

¹ Supported by a grant from the World Health Organization Diarrheal Disease Control Program and the Thrasher Research Fund. Core support from the ICMR to AIIMS is acknowledged.

² The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

³ To whom reprint requests should be addressed.

Manuscript received 19 May 1995. Revision accepted 23 October 1995.

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