title: Zinc deficiency in children with environmental enteropathy-development of new strategies: report from an expert workshop.
abstract: Zinc deficiency is a major cause of childhood morbidity and mortality. The WHO/UNICEF strategy for zinc supplementation as adjunctive therapy for diarrhea is poorly implemented. A conference of experts in zinc nutrition and gastrointestinal disorders was convened to consider approaches that might complement the current recommendation and what research was needed to develop these approaches. Several key points were identified. The design of novel zinc interventions would be facilitated by a better understanding of how disturbed gut function, such as environmental (or tropical) enteropathy, affects zinc absorption, losses, and homeostasis. Because only 10% of zinc stores are able to be rapidly turned over, and appear to be rapidly depleted by acute intestinal illness, they are probably best maintained by complementary regular supplementation in a primary prevention strategy rather than secondary prevention triggered by acute diarrhea. The assessment of zinc status is challenging and complex without simple, validated measures to facilitate field testing of novel interventions. Zinc bioavailability may be a crucial factor in the success of primary prevention strategies, and a range of options, all still inadequately explored, might be valuable in improving zinc nutrition. Some therapeutic actions of zinc on diarrhea seem attributable to pharmacologic effects, whereas others are related to the reversal of deficiency (ie, nutritional). The distinction between these 2 mechanisms cannot be clarified given the insensitivity of serum zinc to identify subclinical deficiency states. Why zinc seems to be less effective than expected at all ages, and ineffective for secondary prevention of diarrhea in children <12 mo of age, remains unclear. It was concluded that a reframing of the current recommendation is warranted with consideration of how to better optimize and deliver zinc and whether to provide a complementary public health primary prevention zinc strategy. This requires careful consideration of the zinc product to be used as well as strategies for its delivery.
authors.affiliation: From the School of Medicine, Flinders University of South Australia, Adelaide, Australia (GPY, EKM, GLG, and ILB); Washington University School of Medicine, St Louis, MO (DHA and MJM); Yale University School of Medicine, New Haven, CT (HJB); the Department of Medical Gastroenterology, Christian Medical College Vellore, Vellore, India (BSR); and Enteric and Diarrheal Diseases, the Bill & Melinda Gates Foundation, Seattle, WA (TGB).
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Young
authors.affiliation: From the School of Medicine, Flinders University of South Australia, Adelaide, Australia (GPY, EKM, GLG, and ILB); Washington University School of Medicine, St Louis, MO (DHA and MJM); Yale University School of Medicine, New Haven, CT (HJB); the Department of Medical Gastroenterology, Christian Medical College Vellore, Vellore, India (BSR); and Enteric and Diarrheal Diseases, the Bill & Melinda Gates Foundation, Seattle, WA (TGB).
authors.forename: Elissa K
authors.initials: EK
authors.lastname: Mortimer
authors.affiliation: From the School of Medicine, Flinders University of South Australia, Adelaide, Australia (GPY, EKM, GLG, and ILB); Washington University School of Medicine, St Louis, MO (DHA and MJM); Yale University School of Medicine, New Haven, CT (HJB); the Department of Medical Gastroenterology, Christian Medical College Vellore, Vellore, India (BSR); and Enteric and Diarrheal Diseases, the Bill & Melinda Gates Foundation, Seattle, WA (TGB).
authors.forename: Geetha L
authors.initials: GL
authors.lastname: Gopalsamy
authors.affiliation: From the School of Medicine, Flinders University of South Australia, Adelaide, Australia (GPY, EKM, GLG, and ILB); Washington University School of Medicine, St Louis, MO (DHA and MJM); Yale University School of Medicine, New Haven, CT (HJB); the Department of Medical Gastroenterology, Christian Medical College Vellore, Vellore, India (BSR); and Enteric and Diarrheal Diseases, the Bill & Melinda Gates Foundation, Seattle, WA (TGB).
authors.forename: David H
authors.initials: DH
authors.lastname: Alpers
authors.affiliation: From the School of Medicine, Flinders University of South Australia, Adelaide, Australia (GPY, EKM, GLG, and ILB); Washington University School of Medicine, St Louis, MO (DHA and MJM); Yale University School of Medicine, New Haven, CT (HJB); the Department of Medical Gastroenterology, Christian Medical College Vellore, Vellore, India (BSR); and Enteric and Diarrheal Diseases, the Bill & Melinda Gates Foundation, Seattle, WA (TGB).
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Binder
authors.affiliation: From the School of Medicine, Flinders University of South Australia, Adelaide, Australia (GPY, EKM, GLG, and ILB); Washington University School of Medicine, St Louis, MO (DHA and MJM); Yale University School of Medicine, New Haven, CT (HJB); the Department of Medical Gastroenterology, Christian Medical College Vellore, Vellore, India (BSR); and Enteric and Diarrheal Diseases, the Bill & Melinda Gates Foundation, Seattle, WA (TGB).
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
authors.affiliation: From the School of Medicine, Flinders University of South Australia, Adelaide, Australia (GPY, EKM, GLG, and ILB); Washington University School of Medicine, St Louis, MO (DHA and MJM); Yale University School of Medicine, New Haven, CT (HJB); the Department of Medical Gastroenterology, Christian Medical College Vellore, Vellore, India (BSR); and Enteric and Diarrheal Diseases, the Bill & Melinda Gates Foundation, Seattle, WA (TGB).
authors.forename: Balakrishnan S
authors.initials: BS
authors.lastname: Ramakrishna
authors.affiliation: From the School of Medicine, Flinders University of South Australia, Adelaide, Australia (GPY, EKM, GLG, and ILB); Washington University School of Medicine, St Louis, MO (DHA and MJM); Yale University School of Medicine, New Haven, CT (HJB); the Department of Medical Gastroenterology, Christian Medical College Vellore, Vellore, India (BSR); and Enteric and Diarrheal Diseases, the Bill & Melinda Gates Foundation, Seattle, WA (TGB).
authors.forename: Ian L
authors.initials: IL
authors.lastname: Brown
authors.affiliation: From the School of Medicine, Flinders University of South Australia, Adelaide, Australia (GPY, EKM, GLG, and ILB); Washington University School of Medicine, St Louis, MO (DHA and MJM); Yale University School of Medicine, New Haven, CT (HJB); the Department of Medical Gastroenterology, Christian Medical College Vellore, Vellore, India (BSR); and Enteric and Diarrheal Diseases, the Bill & Melinda Gates Foundation, Seattle, WA (TGB).
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Brewer
mesh_terms: D001682:Biological Availability; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy*; D019587:Dietary Supplements; D005260:Female; D006706:Homeostasis; D006801:Humans; D007422:Intestines / Q000473:pathology; D008297:Male; D009017:Morbidity; D015596:Nutrition Assessment; D009752:Nutritional Status; D064167:Recommended Dietary Allowances; D014944:World Health Organization; D015032:Zinc / Q000008:administration & dosage* / Q000172:deficiency* / Q000493:pharmacokinetics
chemical_list: D015032:Zinc