Original Article
European Journal of Clinical Nutrition advance online publication 11 November 2009; doi: 10.1038/ejcn.2009.127
Supplementing iron and zinc: double blind, randomized evaluation of separate or combined delivery
Contributors: SC, AB, RB, SA, MW, KZ contributed to study design. SA, SB, MW, KMR, TR, AM, NB contributed to collection of data. SC, RB contributed to analysis of data. SC prepared the first draft of the manuscript. All authors provided significant advice, contributed to, and approved the final manuscript.
This study was registered in clinicaltrials.gov (identifier number NCT00470158), and approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (H.22.05.03.11.C2) and the International Centre for Diarrhoeal Disease Research, Bangladesh Ethical Review Committee (2005-040).
S Chang1, S El Arifeen2, S Bari2, M A Wahed2, K M Rahman2, M T Rahman2, A B A Mahmud2, N Begum2, K Zaman2, A H Baqui3 and R E Black3
- 1Johns Hopkins Medical Institutions, Agency for Healthcare Research and Quality, Rockville, MD, USA
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
- 3Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Correspondence: Dr S Chang, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA. E-mail: Stephanie.chang@ahrq.gov
Received 28 February 2009; Revised 26 July 2009; Accepted 27 July 2009; Published online 11 November 2009.
Abstract
Background/Objectives:
Many children have diets deficient in both iron and zinc, but there has been some evidence of negative interactions when they are supplemented together. The optimal delivery approach would maximize clinical benefits of both nutrients. We studied the effectiveness of different iron and zinc supplement delivery approaches to improve diarrhea and anemia in a rural Bangladesh population.
Study Design:
Randomized, double blind, placebo-controlled factorial community trial.
Results:
Iron supplementation alone increased diarrhea, but adding zinc, separately or together, attenuated these harmful effects. Combined zinc and iron was as effective as iron alone for iron outcomes. All supplements were vomited <1% of the time, but combined iron and zinc were vomited significantly more than any of the other supplements. Children receiving zinc and iron (together or separately) had fewer hospitalizations. Separating delivery of iron and zinc may have some additional benefit in stunted children.
Conclusions:
Separate and combined administration of iron and zinc are equally effective for reducing diarrhea, hospitalizations and improving iron outcomes. There may be some benefit in separate administration in stunted children.
Keywords:
iron, zinc, supplement, delivery, interaction, diarrhea
