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Community and International Nutrition

Zinc Supplementation Improved Length Growth Only in Anemic Infants in a Multi-Country Trial of Iron and Zinc Supplementation in South-East Asia^1,2

³ Department Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK; ⁴ Institute of Nutrition, Mahidol University, 73170 Bangkok, Thailand; ⁵ UR-106, Nutrition, Food and Societies, Institute of Research for Development, 34394 Montpellier, France; ⁶ Center for Child Survival, University of Indonesia, 16424 Jakarta, Indonesia; ⁷ National Institute of Nutrition, Hanoi, Vietnam; and ⁸ Department Public Health, Medical Faculty, Trisakti University, 11440 Jakarta, Indonesia

^* To whom correspondence should be addressed. E-mail: wieringa{at}tiscali.nl.

Data from 4 randomized, placebo-controlled, double-blind trials in Indonesia, Thailand, and Vietnam, the South-East Asian Multicountry Trial on Iron and Zinc supplementation in Infants (SEAMTIZI), were pooled to investigate the effects of iron and zinc supplementation infant growth. Infants (n = 2451) aged 4–6 mo old were supplemented with iron (10 mg/d) and/or zinc (10 mg/d) for 6 mo. Overall, neither iron nor zinc supplementation prevented the progressive growth faltering during infancy, which is common in many developing countries. However, infants who received zinc were less likely to be stunted at the end of the supplementation period (odds ratio 0.80; 95% CI 0.64–1.0). Boys had a 30% higher risk of being stunted at the end of the study than girls (P < 0.01). Baseline factors modified the effect of supplementation, with infants anemic at baseline (hemoglobin < 105 g/L) benefiting from zinc supplementation, with an estimated increase in height-for-age Z-score (HAZ) score of 0.17 (P < 0.01), but with no effect of zinc supplementation on growth in infants not anemic at baseline. Iron supplementation negatively affected linear growth in infants with a birth weight of >3500 g (estimated effect size, –0. 14 HAZ score; P < 0.01), but with no significant effect in infants with a lower birth weight. This study shows that blanket supplementation of infants with iron or zinc will not be beneficial to all recipients and may have adverse effects in some. Hence, interventions such as iron and zinc supplementation for infants should be restricted to subgroups in which there is a clear benefit and baseline factors should be considered and characterized before implementing new policies.