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Meta-Analysis
. 2023 Jul 10;81(8):967-987.
doi: 10.1093/nutrit/nuac098.

Toward revising dietary zinc recommendations for children aged 0 to 3 years: a systematic review and meta-analysis of zinc absorption, excretion, and requirements for growth

Marena Ceballos-Rasgado  1 , Nicola M Lowe  1 , Victoria H Moran  1 , Andrew Clegg  2 , Simonette Mallard  3 , Catherine Harris  2 , Jason Montez  4 , Maria Xipsiti  5
Affiliations
Meta-Analysis

Toward revising dietary zinc recommendations for children aged 0 to 3 years: a systematic review and meta-analysis of zinc absorption, excretion, and requirements for growth

Marena Ceballos-Rasgado et al. Nutr Rev. .

Abstract

Context: The Food and Agriculture Organization of the United Nations and the World Health Organization are updating their dietary zinc recommendations for children aged 0 to 3 years.

Objective: The aim of this review was to retrieve and synthesize evidence regarding zinc needs for growth as well as zinc losses, absorption, and bioavailability from the diet.

Data sources: MEDLINE, Embase, and Cochrane Library databases were searched electronically from inception to August 2020. Studies assessing the above factors in healthy children aged 0 to 9 years were included, with no limits on study design or language.

Data extraction: Ninety-four studies reporting on zinc content in tissue (n = 27); zinc absorption (n = 47); factors affecting zinc bioavailability (n = 30); and endogenous zinc losses via urine, feces, or integument (n = 40) met the inclusion criteria. Four reviewers extracted data and two reviewers checked for accuracy.

Data analyses: Studies were synthesized narratively, and meta-analyses of zinc losses and gains as well the subgroups of age, type of feeding, country's income, and molar ratio of phytate to zinc were conducted. Meta-analysis revealed an overall mean (95%CI) urinary and endogenous fecal zinc excretion of 17.48 µg/kg/d (11.80-23.15; I2 = 94%) and 0.07 mg/kg/d (0.06-0.08; I2 = 82%), respectively, with a mean fractional zinc absorption of 26.75% (23.69-29.81; I2 = 99%). Subgrouping by age revealed differences in mean values associated with the transition from milk-based diets to solid food during the first 3 years of life.

Conclusion: This review synthesizes data that may be used to formulate zinc requirements in young children. Results should be interpreted with caution because of considerable heterogeneity in the evidence.

Systematic review registration: PROSPERO registration number CRD42020215236.

Keywords: children; infants; meta-analysis; systematic review; zinc; zinc absorption; zinc bioavailability; zinc excretion; zinc requirements.

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Figures

Figure 1
Figure 1
Flow diagram of the literature search process. Abbreviation: Zn, zinc.
Figure 2
Figure 2
Forest plot of urinary zinc excretion (µg/kg/d), by age group.
Figure 3
Figure 3
Forest plot of total fecal zinc excretion (mg/kg/d), with studies ranked by zinc intake.
Figure 4
Figure 4
Forest plot of endogenous fecal zinc excretion (mg/d/kg), by age group.
Figure 5
Figure 5
Forest plot of fractional zinc absorption (%) by age group, ranked by zinc intake from 24- hour studies.
See this image and copyright information in PMC

References

    1. Ekweagwu E, Agwu AE, Madukwe E. The role of micronutrients in child health: a review of the literature. Afr J Biotechnol. 2008;7:3804–3810. [10.5897/AJB08.388] - DOI
    1. Liu E, Pimpin L, Shulkin M, et al. Effect of zinc supplementation on growth outcomes in children under 5 years of age. Nutrients. 2018;10:377. - PMC - PubMed
    1. Kogan S, Sood A, Garnick MS. Zinc and wound healing: a review of zinc physiology and clinical applications. Wounds. 2017;29:102–106. - PubMed
    1. Yakoob MY, Theodoratou E, Jabeen A, et al. Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria. BMC Public Health. 2011;11(suppl 3):S23. - PMC - PubMed
    1. Warthon-Medina M, Moran VH, Stammers AL, et al. Zinc intake, status and indices of cognitive function in adults and children: a systematic review and meta-analysis. Eur J Clin Nutr. 2015;69:649–661. - PubMed

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