In developing countries, deficiencies of micronutrients are thought to have a major impact on child development; however, a consensus on the specific relationship between dietary zinc intake and cognitive function remains elusive. The aim of this systematic review was to examine the relationship between zinc intake, status and indices of cognitive function in children and adults. A systematic literature search was conducted using EMBASE, MEDLINE and Cochrane Library databases from inception to March 2014. Included studies were those that supplied zinc as supplements or measured dietary zinc intake. A meta-analysis of the extracted data was performed where sufficient data were available. Of all of the potentially relevant papers, 18 studies met the inclusion criteria, 12 of which were randomised controlled trials (RCTs; 11 in children and 1 in adults) and 6 were observational studies (2 in children and 4 in adults). Nine of the 18 studies reported a positive association between zinc intake or status with one or more measure of cognitive function. Meta-analysis of data from the adult’s studies was not possible because of limited number of studies. A meta-analysis of data from the six RCTs conducted in children revealed that there was no significant overall effect of zinc intake on any indices of cognitive function: intelligence, standard mean difference of <0.001 (95% confidence interval (CI) –0.12, 0.13) P=0.95; executive function, standard mean difference of 0.08 (95% CI, –0.06, 022) P=0.26; and motor skills standard mean difference of 0.11 (95% CI –0.17, 0.39) P=0.43. Heterogeneity in the study designs was a major limitation, hence only a small number (n=6) of studies could be included in the meta-analyses. Meta-analysis failed to show a significant effect of zinc supplementation on cognitive functioning in children though, taken as a whole, there were some small indicators of improvement on aspects of executive function and motor development following supplementation but high-quality RCTs are necessary to investigate this further.
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The original conception of the systematic review was undertaken by the EURRECA network and coordinated by partners based at Wageningen University (WU), the Netherlands and the University of East Anglia (UEA), United Kingdom, Susan Fairweather-Tait (UEA), Lisette de Groot (WU), Pieter van’t Veer (WU), Kate Ashton (UEA), Amélie Casgrain (UEA), Adriënne Cavelaars (WU), Rachel Collings (UEA), Rosalie Dhonukshe-Rutten (WU), Esmée Doets (WU), Linda Harvey (UEA) and Lee Hooper (UEA) designed and developed the review protocol and search strategy. We thank the EURRECA Network of Excellence and to Sujata Patel, Joseph Saavedra, Nick Kenworthy, Sarah Richardson-Owen and Christine Cockburn for assistance with screening, data extraction of studies and Fiona Dykes for helpful discussions. NML, MW-M, A-LS, VHM, PQ and SD collected and analysed the data. LS-M and MN were also involved in the screening process. All authors were involved in writing the manuscript. We like to acknowledge networking support by Zn-Net COST Action TD1304, The Network for the Biology of Zinc, (http://www.cost.eu/COST_Actions/fa/Actions/TD1304). Names for PubMed indexing: Warthon-Medina, Hall Moran, Stammers, Dillon, Qualter, Nissenhohn, Serra-Majem, Lowe. This study has been supported by the EURRECA Network of Excellence (http://www.eurreca.org), which was funded by the Commission of the European Communities, specific Research, Technology and Development (RTD) Programme Quality of Life and Management of Living Resources, within the Sixth Framework Programme, contract no. 036196. Member of the Zinc-Net COST Action TD1304, http://www.cost.eu/domains_actions/fa/Actions/TD1304. This report does not necessarily reflect the Commission’s views or its future policy in this area.
The authors declare no conflict of interest.
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Warthon-Medina, M., Moran, V., 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 69, 649–661 (2015). https://doi.org/10.1038/ejcn.2015.60
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