title: Zinc and rehabilitation from severe protein-energy malnutrition: higher-dose regimens are associated with increased mortality.
abstract: A randomized, double-blind trial was undertaken to measure the effects of zinc supplementation on catch-up growth in severe protein-energy malnutrition, with particular reference to linear growth. One hundred forty-one children between the ages of 6 mo and 3 y were enrolled after admission to a nutritional rehabilitation unit in Dhaka, Bangladesh, and randomly assigned to receive elemental zinc by mouth, 1.5 mg/kg for 15 d, 6.0 mg/kg for 15 d, or 6.0 mg/kg for 30 d, and thereafter they were followed for a total of 90 d. Anthropometric outcome measures included change in knee-heel length, midupper arm circumference, subscapular and triceps skinfold thicknesses, and change in height-for-age, weight-for-age, and weight-for-height z scores. Higher zinc doses were not associated with significant change in any anthropometric measurement, but mortality was significantly greater in children who received high-dose zinc (6.0 mg/kg) initially as opposed to those who received low-dose zinc supplementation (1.5 mg/kg) (Yates-corrected chi-square P value of 0.033 and a risk ratio of 4.53; 95% CI: 1.09 < risk ratio < 18.8). We conclude that there is no benefit to using high-dose zinc supplementation regimens and that they could contribute to increased mortality in severely malnourished children.
authors.affiliation: Department of Child Life and Health, University of Edinburgh, Scotland, United Kingdom. cd1c@clinmed.gla.ac.uk
authors.forename: C P
authors.initials: CP
authors.lastname: Doherty
authors.forename: M A
authors.initials: MA
authors.lastname: Sarkar
authors.forename: M S
authors.initials: MS
authors.lastname: Shakur
authors.forename: S C
authors.initials: SC
authors.lastname: Ling
authors.forename: R A
authors.initials: RA
authors.lastname: Elton
authors.forename: W A
authors.initials: WA
authors.lastname: Cutting
mesh_terms: D000886:Anthropometry; D001459:Bangladesh; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006128:Growth / Q000187:drug effects; D006801:Humans; D007223:Infant; D011379:Prognosis; D011502:Protein-Energy Malnutrition / Q000188:drug therapy* / Q000401:mortality / Q000534:rehabilitation; D012047:Rehabilitation Centers; D015032:Zinc / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D015032:Zinc