title: Effects of separate delivery of zinc or zinc and vitamin A on hemoglobin response, growth, and diarrhea in young Peruvian children receiving iron therapy for anemia.
abstract: BACKGROUND
  Anemia is the most prevalent nutritional deficiency in the world. Attempts to improve iron indexes are affected by deficiency of and interaction between other micronutrients.
  
  
  OBJECTIVE
  Our goal was to assess whether zinc added to iron treatment alone or with vitamin A improves iron indexes and affects diarrheal episodes.
  
  
  METHODS
  This was a randomized, placebo-controlled, double-blind trial conducted in Peru. Anemic children aged 6-35 mo were assigned to 3 treatment groups: ferrous sulfate (FS; n = 104), ferrous sulfate and zinc sulfate (FSZn; n = 109), and ferrous sulfate, zinc sulfate, and vitamin A (FSZnA; n = 110). Vitamin A or its placebo was supplied only once; iron and zinc were provided under supervision >/=1 h apart 6 d/wk for 18 wk.
  
  
  RESULTS
  The prevalence of anemia was 42.97%. The increase in hemoglobin in the FS group (19.5 g/L) was significantly less than that in the other 2 groups (24.0 and 23.8 g/L in the FSZn and FSZnA groups, respectively). The increase in serum ferritin in the FS group (24.5 mug/L) was significantly less than that in the other 2 groups (33.0 and 30.8 mug/L in the FSZn and FSZnA groups, respectively). The median duration of diarrhea and the mean number of stools per day was significantly higher in the FS group than in other 2 groups (P < 0.005).
  
  
  CONCLUSIONS
  Adding zinc to iron treatment increases hemoglobin response, improves iron indexes, and has positive effects on diarrhea. No additional effect of vitamin A was found.
authors.affiliation: Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Karl
authors.initials: K
authors.lastname: Alarcon
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Kolsteren
authors.forename: Ana M
authors.initials: AM
authors.lastname: Prada
authors.forename: Ana M
authors.initials: AM
authors.lastname: Chian
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Velarde
authors.forename: Iris L
authors.initials: IL
authors.lastname: Pecho
authors.forename: Tom F
authors.initials: TF
authors.lastname: Hoeree
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000453:epidemiology; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy* / Q000453:epidemiology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005296:Ferrous Compounds / Q000627:therapeutic use*; D006454:Hemoglobins / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*; D019287:Zinc Sulfate / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005296:Ferrous Compounds; D006454:Hemoglobins; D014801:Vitamin A; C020748:ferrous sulfate; D019287:Zinc Sulfate