title: Rural Beninese Children Are at Risk of Zinc Deficiency According to Stunting Prevalence and Plasma Zinc Concentration but Not Dietary Zinc Intakes.
abstract: BACKGROUND
  Three commonly recommended indicators for risk assessment of population zinc deficiency are stunting rates among children aged <5 y, prevalence of inadequate dietary zinc intake, and prevalence of low plasma zinc (PZn). Data on zinc status in Benin are mainly drawn from stunting rates and data on PZn and dietary zinc intake are lacking.
  
  
  OBJECTIVE
  The aims of this study were 1) to assess the risk of zinc deficiency in preschool and school-age children from rural communities in northern Benin by means of the 3 indicators for population assessment, 2) to evaluate their level of agreement, and 3) to identify predictors of PZn and height-for-age z scores (HAZ).
  
  
  METHODS
  We analyzed preintervention data collected during 2 efficacy trials and cross-sectionally assessed the risk of zinc deficiency in preschool (1-5 y, n = 326) and school-age children (5-10 y, n = 272) by 1) conducting a 3-d weighed food record survey, coupled with direct zinc and phytic acid analysis of consumed foodstuffs, and calculating usual dietary zinc intakes in a subsample of school-age children (n = 36); 2) analyzing PZn in all children (n = 598); and 3) measuring anthropometry indexes for assessment of stunting (HAZ <-2 SD) in all children (n = 594) and in <5-y-old children only (n = 273). We derived predictors of PZn and HAZ by using multivariate regression with mixed-effect models.
  
  
  RESULTS
  Prevalence of inadequate intakes of zinc ranged from 11% to 80% depending on whether the estimated average requirements (EARs) by the International Zinc Nutrition Consultative Group or the EARs derived from the WHO's recommended nutrient intakes were used. Prevalence of low PZn adjusted for acute-phase protein status was 45.7%, with higher rates among preschoolers than school-age children (P = 0.002). The stunting rate in <5-y-old children was 51.3%. PZn was predicted by age, methodologic factors, and socioeconomic status, whereas HAZ was predicted by age, sex, hemoglobin, and socioeconomic status.
  
  
  CONCLUSIONS
  The prevalence of <5-y stunting and the prevalence of low PZn indicate that the risk of zinc deficiency is elevated in this population. Risk estimates based on the prevalence of inadequacy of zinc intakes varied depending on the EARs used, and a consensus would facilitate nutrition survey evaluations. These trials were registered at clinicaltrials.gov as NCT01472211 and NCT01790321.
authors.affiliation: Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland; valeria.galetti@hest.ethz.ch.
authors.forename: Valeria
authors.identifier: http://orcid.org/0000-0002-7867-9960
authors.initials: V
authors.lastname: Galetti
authors.affiliation: Laboratory of Human Nutrition, Faculty of Agricultural Sciences, University of Abomey-Calavi, Cotonou, Benin;
authors.forename: Comlan Evariste S
authors.initials: CE
authors.lastname: Mitchikpè
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; and.
authors.forename: Prosper
authors.identifier: http://orcid.org/0000-0003-3824-2788
authors.initials: P
authors.lastname: Kujinga
authors.affiliation: Natitingou Health Zone, Ministry of Health, Natitingou, Benin.
authors.forename: Félicien
authors.initials: F
authors.lastname: Tossou
authors.affiliation: Laboratory of Human Nutrition, Faculty of Agricultural Sciences, University of Abomey-Calavi, Cotonou, Benin;
authors.forename: D Joseph
authors.identifier: http://orcid.org/0000-0002-3677-4986
authors.initials: DJ
authors.lastname: Hounhouigan
authors.affiliation: Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland;
authors.forename: Michael B
authors.initials: MB
authors.lastname: Zimmermann
authors.affiliation: Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland;
authors.forename: Diego
authors.identifier: http://orcid.org/0000-0002-7366-2182
authors.initials: D
authors.lastname: Moretti
mesh_terms: D000209:Acute-Phase Proteins; D001541:Benin / Q000453:epidemiology; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet; D004034:Diet Surveys; D005260:Female; D006130:Growth Disorders / Q000097:blood / Q000453:epidemiology*; D006454:Hemoglobins; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009751:Nutritional Requirements; D009752:Nutritional Status; D010833:Phytic Acid / Q000008:administration & dosage / Q000097:blood; D015995:Prevalence; D012424:Rural Population; D012959:Socioeconomic Factors; D015032:Zinc / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency*
chemical_list: D000209:Acute-Phase Proteins; D006454:Hemoglobins; D010833:Phytic Acid; D015032:Zinc
keywords: Benin; dietary zinc intake; plasma zinc concentration; stunting; zinc status