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. 2022 Feb 19;14(4):883.
doi: 10.3390/nu14040883.

Applying Zinc Nutrient Reference Values as Proposed by Different Authorities Results in Large Differences in the Estimated Prevalence of Inadequate Zinc Intake by Young Children and Women and in Cameroon

Demewoz Haile  1   2 , Kenneth H Brown  1   2 , Christine M McDonald  1   2   3 , Hanqi Luo  1   2   4 , Michael Jarvis  2 , Ismael Teta  5 , Alex Ndjebayi  5 , Guintang Assiene Jules Martial  6 , Stephen A Vosti  2   7 , Reina Engle-Stone  1   2
Affiliations

Applying Zinc Nutrient Reference Values as Proposed by Different Authorities Results in Large Differences in the Estimated Prevalence of Inadequate Zinc Intake by Young Children and Women and in Cameroon

Demewoz Haile et al. Nutrients. .

Abstract

Nutrient reference values (NRVs) for zinc set by several expert groups differ widely and may affect the predicted prevalence of inadequate zinc intake. We examined this possibility using NRVs published by four different authorities and nationally representative dietary intake data collected among children aged 12-59 months and women in Cameroon. Usual zinc intake was estimated from 24 h recall data using the National Cancer Institute method. Prevalences of total zinc intake below the dietary requirement and of "absorbable zinc intake" below the physiological requirement were estimated using NRVs published by the World Health Organization (WHO), US Institute of Medicine (IOM), International Zinc Nutrition Consultative Group (IZiNCG), and European Food Safety Authority (EFSA). The prevalence of inadequate zinc intake ranged from 10% (IZiNCG-physiological requirement, 95% CI 7-13%) to 81% (EFSA-physiological requirement, 95% CI 78-84%) among children and 9% (WHO-physiological requirement, 95% CI 8-11.0%) to 94% (IOM-physiological requirement, 95% CI 92-95%) among women These differences in the prevalence of inadequate intake translated into sizeable differences in the predicted benefit and cost-effectiveness of zinc fortification programs. Depending on the NRVs applied, assessments differ regarding the need for and design of zinc fortification programs. Efforts are needed to harmonize NRVs for zinc.

Keywords: Cameroon; children; dietary assessment; fortification; modeling; women; zinc.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Total dietary and absorbable zinc intake distributions for children aged 12–59 months in Cameroon: (A) South macro-region, (B) North macro-region, (C) Yaoundé/Douala, (D) National. Absorbable zinc intake was estimated based on Miller’s equation [24].
Figure 2
Figure 2
Total dietary and absorbable zinc intake distributions among women of reproductive age in Cameroon: (A) South macro-region, (B) North macro-region, (C) Yaoundé/Douala, (D) National. Absorbable zinc intake was estimated based on Miller’s equation [23].
Figure 3
Figure 3
Estimated prevalence of inadequate zinc intake among children aged 12–59 months in Cameroon according to NRVs published by different expert groups. Error bars indicate standard errors. EFSA, European Food Safety Authority; IOM, US Institute of Medicine; IZiNCG, International Zinc Nutrition Consultative Group; WHO, World Health Organization.
Figure 4
Figure 4
Estimated prevalence of inadequate zinc intake among women of reproductive age in Cameroon according to different NRVs. Error bars indicate standard errors. EFSA, European Food Safety Authority; IOM, US Institute of Medicine; IZiNCG, International Zinc Nutrition Consultative Group; WHO, World Health Organization.
Figure 5
Figure 5
Effect of the level of zinc fortification of bouillon cube (mg zinc/g bouillon cube) on the prevalence of inadequate zinc intake among children in the presence of wheat flour fortification (95 mg zinc/kg flour) according to different NRVs. (A) South-macro region, (B) North macro-region, (C) Yaoundé/Douala, (D) National. WHO-PR, World Health Organization—physiological requirement; WHO-DR, World Health Organization—dietary requirement; IOM-PR, Institute of Medicine—physiological requirement; IOM-DR, Institute of Medicine—dietary requirement; IZiNCG-PR, International Zinc Nutrition Consultative Group—physiological requirement; IZiNCG-DR, International Zinc Nutrition Consultative Group—dietary requirement; EFSA-PR, European Food Safety Authority—physiological requirement; EFSA-DR, European Food Safety Authority—dietary requirement.
Figure 6
Figure 6
Effect of the level of zinc fortification of bouillon cube (mg zinc/g bouillon cube) on the prevalence of inadequate intake among women in the presence of a wheat flour fortification (95 mg zinc/kg flour) according to different NRVs. (A) South-macro region, (B) North macro-region, (C) Yaoundé/Douala, (D) National. WHO-PR, World Health Organization—physiological requirement; WHO-DR, World Health Organization—dietary requirement; IOM-PR, Institute of Medicine—physiological requirement; IOM-DR, Institute of Medicine—dietary requirement; IZiNCG-PR, International Zinc Nutrition Consultative Group—physiological requirement; IZiNCG-DR, International Zinc Nutrition Consultative Group—dietary requirement; EFSA-PR, European Food Safety Authority—physiological requirement; EFSA-DR, European Food Safety Authority—dietary requirement.
Figure 7
Figure 7
Prevalence (±SE) of zinc intake above the UL, considering the potential contribution of zinc fortification programs among children in Cameroon: estimated based on WHO, IZINCG, IOM, and EFSA UL reference values. EFSA, European Food Safety Authority; IOM, US Institute of Medicine; IZiNCG, International Zinc Nutrition Consultative Group; WHO, World Health Organization; WF, wheat flour; BC, bouillon cubes; UL, tolerable upper intake level.
Figure 8
Figure 8
Prevalence (±SE) of zinc intake above the UL considering the contribution of zinc fortification programs among women in Cameroon: estimated based on WHO, IZINCG, IOM, and EFSA UL reference values. EFSA, European Food Safety Authority; IOM, US Institute of Medicine; IZiNCG, International Zinc Nutrition Consultative Group; WHO, World Health Organization; WF, wheat flour; BC, bouillon cubes; UL, tolerable upper intake level.
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References

    1. Shah D., Sachdev H.P.S. Effect of gestational zinc deficiency on pregnancy outcomes: Summary of observation studies and zinc supplementation trials. Br. J. Nutr. 2001;85:S101–S108. doi: 10.1079/BJN2000301. - DOI - PubMed
    1. Rerksuppaphol S., Rerksuppaphol L. Zinc supplementation enhances linear growth in school-aged children: A randomized controlled trial. Pediatr. Rep. 2018;9:7294. doi: 10.4081/pr.2017.7294. - DOI - PMC - PubMed
    1. Park S.-G., Choi H.-N., Yang H.-R., Yim J.-E. Effects of zinc supplementation on catch-up growth in children with failure to thrive. Nutr. Res. Pract. 2017;11:487–491. doi: 10.4162/nrp.2017.11.6.487. - DOI - PMC - PubMed
    1. Ota E., Mori R., Middleton P., Tobe-Gai R., Mahomed K., Miyazaki C., Bhutta Z.A. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst. Rev. 2015;2015:CD000230. doi: 10.1002/14651858.CD000230.pub5. - DOI - PMC - PubMed
    1. Gupta S., Brazier A.K.M., Lowe N.M. Zinc deficiency in low- and middle-income countries: Prevalence and approaches for mitigation. J. Hum. Nutr. Diet. 2020;33:624–643. doi: 10.1111/jhn.12791. - DOI - PubMed