Original Article

European Journal of Clinical Nutrition (2009) 63, 850–857; doi:10.1038/ejcn.2008.78; published online 28 January 2009

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

Contributors: MK Chhagan planned and completed the current analysis and prepared the manuscript draft. ML Bennish was principal investigator for the study and responsible for study design. J Van den Broeck and KA Luabeya served as Project Directors. N Mpontshane supervised the fieldwork. The manuscript was critically reviewed and approved by all of the authors.

M K Chhagan1,5, J Van den Broeck2, K-KA Luabeya3, N Mpontshane4, K L Tucker5 and M L Bennish6,7

  1. 1Department of Paediatrics and Child Health, University of KwaZulu-Natal, KwaZulu-natal, South Africa
  2. 2Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
  3. 3Africa Centre for Health and Population Studies, University of KwaZulu Natal, Somkhele, South Africa
  4. 4Pharmaceutical Product Development, Cambridge, UK
  5. 5Nutritional Epidemiology Program, Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
  6. 6Mpilonhle, Mtubatuba, South Africa
  7. 7Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

Correspondence: Dr MK Chhagan, Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, 4013, South Africa. E-mail: chhagan@ukzn.ac.za

Received 6 June 2008; Revised 5 October 2008; Accepted 2 December 2008; Published online 28 January 2009.

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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.

Keywords:

Zinc, diarrhoea, clinical trial, stunting, micronutrients, vitamin A

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