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Zinc supplementation in infants born small for gestational age reduces mortality: a prospective, randomized,
S Sazawal1, R E Black, V P Menon
1Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
Insights
Zinc supplementation significantly reduced mortality in small for gestational age infants. This intervention offers a promising strategy to decrease infant mortality, particularly from infectious diseases.
Area of Science:
- Pediatric Nutrition
- Public Health Interventions
- Neonatal Research
Background:
- Infants born small for gestational age (SGA) often exhibit low zinc levels.
- Zinc deficiency is linked to impaired immunity and increased infections in children.
Purpose of the Study:
- To evaluate the impact of zinc supplementation on mortality rates in full-term SGA infants.
- To assess the combined effects of zinc and other micronutrients on infant mortality.
Main Methods:
- A randomized, double-blind, controlled trial involving 1154 SGA infants.
- Infants received either riboflavin, riboflavin with zinc, or riboflavin with a combination of iron, folate, calcium, and phosphorus.
- Mortality was analyzed using survival analysis, assessing zinc and vitamin/mineral effects independently.
Main Results:
- Zinc supplementation showed a significant reduction in mortality (rate ratio: 0.32).
- Supplementation with iron, folate, calcium, and phosphorus did not significantly reduce mortality (rate ratio: 0.88).
Conclusions:
- Zinc supplementation can substantially decrease infectious disease mortality in SGA infants.
- This highlights the critical role of zinc in infant immunity and survival.
Background:
Low birth weight infants have been noted to have low zinc concentrations in cord blood, and zinc deficiency in childhood is associated with reduced immunocompetence and increased infectious disease morbidity. This study investigates whether zinc supplementation of infants born full term and small for gestational age affects mortality.
Methods:
A randomized, double-blind, controlled trial with 2-by-2 factorial design enrolled 1154 full-term small for gestational age infants to receive in syrup 1 of the following: riboflavin; riboflavin and zinc (5 mg as sulfate); riboflavin, calcium, phosphorus, folate, and iron; or riboflavin, zinc, calcium, phosphorus, folate, and iron. A fixed dosage of 5 mL per child was given daily from 30 to 284 days of age. Household visits were made 6 days per week to provide the syrup and conduct surveillance for illness and death. When a child's death was reported, parental reports and medical records were used to ascertain the cause. The effects of zinc and of the combination of iron, folate, calcium, and phosphorus were analyzed by intent to treat. The mortality analysis was performed using a survival analytic approach that models time until death as the dependent variable; all models had 2 terms as independent variables: 1 for the zinc effect and 1 for the vitamin and mineral (calcium and phosphorus, folate and iron) effect.
Results:
Zinc supplementation was associated with significantly lower mortality, with a rate ratio of 0.32 (95% confidence interval: 0.12-0.89). Calcium, phosphorus, folate, and iron supplementation was not associated with a mortality reduction, although a statistically nonsignificant trend toward reduction was observed with a rate ratio of 0.88 (95% confidence interval: 0.36-2.15).
Conclusions:
Zinc supplementation in small for gestational age infants can result in a substantial reduction in infectious disease mortality.