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Randomized Controlled Trial
. 2009 Jul;63(7):850-7.
doi: 10.1038/ejcn.2008.78. Epub 2009 Jan 28.

Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa

M K Chhagan  1 , J Van den Broeck, K-Ka Luabeya, N Mpontshane, K L Tucker, M L Bennish
Affiliations
Randomized Controlled Trial

Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa

M K Chhagan et al. Eur J Clin Nutr. 2009 Jul.

Abstract

Background/objective: The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children. Potential modifying factors, such as stunting, need to be addressed. The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence, and whether this differs between the strata of stunted or HIV-infected children.

Methods: We analyzed data from a randomized, controlled, double-blinded trial (ClinicalTrials.gov NCT00156832) of prophylactic micronutrient supplementation to children aged 6-24 months. Three cohorts of children: 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers, received vitamin A, vitamin A plus zinc or multiple micronutrients, which included vitamin A and zinc. The main outcome was incidence of diarrhoea. Poisson regression was used in intent-to-treat analyses. Stratified analyses followed testing for statistical interaction between intervention and stunting.

Results: We observed no significant differences in overall diarrhoea incidence among treatment arms. Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone (2.04 and 2.23 vs 3.92 episodes/year, respectively, P=0.024). No meaningful subgroup analyses could be done in the cohort of HIV-infected children.

Conclusions: Compared with vitamin A alone, supplementation with zinc and with zinc and multiple micronutrients, reduced diarrhoea morbidity in stunted rural South African children. Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups.

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Conflict of interest statement

Conflict of Interest Statement

KA Luabeya, N Mpontshane, J Van den Broeck and M L Bennish all received salary and travel support form the National Institutes of Health.

Figures

Figure 1
Figure 1
Mean cumulative function for the number of diarrhoea episodes by treatment arm for all cohorts combined * vitamin A Δ vitamin A plus zinc ○ multiple micronutrients
See this image and copyright information in PMC

References

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