Preview

User

Not a user? Register with this site Forgot your password?

Current Pediatrics

Advanced search

A COMMUNITY BASED RANDOMIZED CONTROLLED TRIAL OF IRON AND ZINC SUPPLEMENTATION IN INFANTS: EFFECTS ON GROWTH AND DEVELOPMENT

Abstract

Deficiencies of iron and zinc are associated with delayed development, growth faltering, and increased infectious disease morbidity during infancy and childhood. Combined iron and zinc supplementation may therefore be a logical preventive strategy. Objective: the objective of the study was to compare the effects of combined iron and zinc supplementation in infancy with the effects of iron and zinc as single micronutrients on growth, psychomotor development, and incidence of infectious disease. Design: Indonesian infants (n = 680) were randomly assigned to daily supplementation with 10 mg Fe (Fe group), 10 mg Zn (Zn group), 10 mg Fe and 10 mg Zn (Fe + Zn group), or placebo from 6 to 12 mo of age. Anthropometric indexes, developmental indexes (bay ley scales of infant development; sid), and morbidity were recorded. Results: at 12 mo, two factor analysis of variance showed a significant interaction between Iron and Zinc for weight for age z score, knee heel length, and sid psychomotor development. Weight forage z score was higher in the Zn group than in the placebo and Fe + Zn groups, knee heel length was higher in the Zn and Fe groups than in the placebo group, and the sid psychomotor development index was higher in the Fe group than in the placebo group. No significant effect on morbidity was found. Conclusions: single supplementation with zinc significantly improved growth, and single supplementation with iron significantly improved growth and psychomotor development, but combined supplementation with iron and zinc had no significant effect on growth or development. Combined, simultaneous supplementation with iron and zinc to infants cannot be routinely recommended at the iron to zinc ratio used in this study.
Key words: infants, growth, knee heel length, development, iron, zinc.

About the Authors

T. Lind
Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umea University, Umea
Sweden


B. Lonnerdal
Department of Nutrition, University of California, Davis, CA
United States


H. Stenlund
Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umea University, Umea
Sweden



I. Gamayanti
Community Health and Nutrition Research Laboratories, Faculty of Medicine, Gadjah Mada University, Yogyakarta
Indonesia


D. Ismail
Community Health and Nutrition Research Laboratories, Faculty of Medicine, Gadjah Mada University, Yogyakarta
Indonesia


R. Seswandhana
Community Health and Nutrition Research Laboratories, Faculty of Medicine, Gadjah Mada University, Yogyakarta
Indonesia


L. Persson
International Maternal and Child Health, Uppsala University, Uppsala
Sweden


References

1. Brown K.H., Peerson J.M., Rivera J., Allen L.H. Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: a meta–analysis of randomized controlled trials. Am J. Clin. Nutr. 2002; 75: 1062–1071.

2. Idjradinata P., Pollitt E. Reversal of developmental delays in iron deficient anaemic infants treated with iron. Lancet. 1993; 341: 1–4.

3. Bhutta Z.A., Black R.E., Brown K.H. et al. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group. J. Pediatr. 1999; 135: 689–697.

4. Sandstrom B. Micronutrient interactions: effects on absorption and bioavailability. Br. J. Nutr. 2001; 85: S181B5.

5. Rossander–Hulten L., Brune M., Sandstrom B. et al. Competitive inhibition of iron absorption by manganese and zinc in humans. Am J. Clin. Nutr. 1991; 54: 152–156.

6. Lind T., Lonnerdal B., Stenlund H. et al. Acommunity based randomized controlled trial of iron and zinc supplementation in Indonesian infants: interactions between iron and zinc. Am. J. Clin. Nutr. 2003; 77: 883–890.

7. Dibley M.J., Sadjimin T., Kjolhede C.L., Moulton L.H. Vitamin A supplementation fails to reduce incidence of acute respiratory illness and diarrhea in preschool age Indonesian children. J. Nutr. 1996; 126: 434–442.

8. Kodyat B., Kosen S., de Pee S. Iron deficiency in Indonesia: current situation and intervention. Nutr. Res. 1998; 18: 1953–1963.

9. Dijkhuizen M.A., Wieringa F.T., West C.E. Muherdiyantiningsih, Muhilal. Concurrent micronutrient deficiencies in lactating mothers and their infants in Indonesia. Am J. Clin. Nutr. 2001; 73: 786–791.

10. Kjolhede C.L., Stallings R.Y., Dibley M.J. et al. Serum retinol levels among preschool children in Central Java: demographic and socioeconomic determinants. Int. J. Epidemiol. 1995; 24: 399–403.

11. Ninuk T.S.H., Dibley M.J., Sadjimin T., Serdula M. Food and nutrient intakes of infants and young children in Central Java, Indonesia. Yogyakarta, Indonesia: University of Gadjah Mada. 1997.

12. World Health Organization. Iron deficiency anaemia. Assessment, prevention and control. A guide for programme managers. Geneva: World Health Organization. 2001.

13. World Health Organization. Trace elements in human nutrition and health. Geneva: World Health Organization. 1996.

14. Bayley N. Bayley Scales of Infant Development. San Antonio: The Psychological Corporation. 1993.

15. Kuczmarski R.J., Ogden C.L., Guo S.S. et al. 2002 CDC growth charts for the United States: methods and development. Vital Health Stat. 2002; 246 (1): 190.

16. Perrone L., Salerno M., Gialanella G. et al. Long term zinc and iron supplementation in children of short stature: effect of growth and on trace element content in tissues. J. Trace Elem. Med. Biol. 1999; 13: 51–56.

17. Dijkhuizen M.A., Wieringa F.T., West C.E. et al. Effects of iron and zinc supplementation in Indonesian infants on micronutrient status and growth. J. Nutr. 2001; 131: 2860–2865.

18. Rosado J.L., Lopez P., Munoz E. et al. Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican preschoolers. Am. J. Clin. Nutr. 1997; 65: 13–19.

19. Zlotkin S., Arthur P., Schauer C. et al. Homefortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. J. Nutr. 2003; 133: 1075–1080.

20. Moffatt M.E., Longstaffe S., Besant J., Dureski C. Prevention of iron deficiency and psychomotor decline in high risk infants through use of ironBfortified infant formula: a randomized clinical trial. J. Pediatr. 1994; 125: 527–534.

21. Williams J., Wolff A., Daly A. et al. Iron supplemented formula milk related to reduction in psychomotor decline in infants from inner city areas: randomised study. BMJ. 1999; 318: 693–697.

22. Pollitt E. Developmental sequel from early nutritional deficiencies: conclusive and probability judgements. J. Nutr. 2000; 130: 350–353.

23. Cavan K.R., Gibson R.S., Grazioso C.F. et al. Growth and body composition of periurban Guatemalan children in relation to zinc status: a longitudinal zinc intervention trial. Am. J. Clin. Nutr. 1993; 57: 344–352.

24. Sazawal S., Bentley M., Black R.E. et al. Effect of zinc supplementation on observed activity in low socioeconomic Indian preschool children. Pediatrics. 1996; 98: 1132–1137.

25. Bentley M.E., Caulfield L.E., Ram M. et al. Zinc supplementation affects the activity patterns of rural Guatemalan infants. J. Nutr. 1997; 127: 1333–1338.

26. Ashworth A., Morris S.S., Lira P.I., Grantham-McGregor S.M. Zinc supplementation, mental development and behaviour in low birth weight term infants in northeast Brazil. Eur. J. Clin. Nutr. 1998; 52: 223–227.

27. Castillo-Duran C., Perales C.G., Hertrampf E.D. et al. Effect of zinc supplementation on development and growth of Chilean infants. J. Pediatr. 2001; 138: 229–235.

28. Hamadani J.D., Fuchs G.J., Osendarp S.J. et al. Randomized controlled trial of the effect of zinc supplementation on the mental development of Bangladeshi infants. Am. J. Clin. Nutr. 2001; 74: 381–386.

29. Penny M.E., Peerson J.M., Marin R.M. et al. Randomized, community based trial of the effect of zinc supplementation, with and without other micronutrients, on the duration of persistent childhood diarrhea in Lima, Peru. J. Pediatr. 1999; 135: 208–217.

30. Baqui A.H., Zaman K., Persson L.А. et al. Simultaneous weekly supplementation of iron and zinc is associated with lower morbidity due to diarrhea and acute lower respiratory infection in Bangladeshi infants. J. Nutr. 2003; 133: 4150–4157.

31. Solomons N.W., Jacob R.A. Studies on the bioavailability of zinc in humans: effects of heme and nonheme iron on the absorption of zinc. Am. J. Clin. Nutr. 1981; 34: 475–482.

32. Valberg L.S., Flanagan P.R., Chamberlain M.J. Effects of iron, tin and copper on zinc absorption in humans. Am. J. Clin. Nutr. 1984; 40: 536–541.

33. Sandstrom B., Davidsson L., Cederblad A., Lonnerdal B. Oral iron, dietary ligands and zinc absorption. J. Nutr. 1985; 115: 411–414.

34. Crofton R.W., Gvozdanovic D., Gvozdanovic S. et al. Inorganic zinc and the intestinal absorption of ferrous iron. Am J. Clin. Nutr. 1989; 50: 141–144.

35. Solomons N.W. Competitive interaction of iron and zinc in the diet: consequences for human nutrition. J. Nutr. 1986; 116: 927–935.

36. Haschke F., Ziegler E.E., Edwards B.B., Fomon S.J. Effect of iron fortification of infant formula on trace mineral absorption. J. Pediatr. Gastroenterol. Nutr. 1986; 5: 768–773.

37. Fairweather-Tait S.J., Wharf S.G., Fox T.E. Zinc absorption in infants fed iron fortified weaning food. Am J. Clin. Nutr. 1995; 62: 785–789.

38. Davidsson L., Almgren A., Sandstrom B., Hurrell R.F. Zinc absorption in adult humans: the effect of iron fortification. Br. J. Nutr. 1995; 74: 417–425.

39. Gunshin H., Mackenzie B., Berger U.V. et al. Cloning and characterization of a mammalian protonBcoupled metalBion transporter. Nature. 1997; 388: 482–488.

40. Yamaji S., Tennant J., Tandy S. et al. Zinc regulates the function and expression of the iron transporters DMT1 and IREG1 in human intestinal Caco–2 cells. FEBS Lett. 2001; 507: 137–141.

41. Idjradinata P., Watkins W.E., Pollitt E. Adverse effect of iron supplementation on weight gain of iron replete young children. Lancet. 1994; 343: 1252–1254.

42. Dewey K.G., Domelloof M., Cohen R.J. et al. Iron supplementation affects growth and morbidity of breastfed infants: results of a randomized trial in Sweden and Honduras. J. Nutr. 2002; 132: 3249–3255.

43. Majumdar I., Paul P., Talib V.H., Ranga S. The effect of iron therapy on the growth of iron replete and iron deplete children. J. Trop. Pediatr. 2003; 49: 84–88.

44. Sazawal S., Black R.E., Bhan M.K. et al. Efficacy of zinc supplementation in reducing the incidence and prevalence of acute diarrhea a community based, double blind, controlled trial. Am J. Clin. Nutr. 1997; 66: 413–418.

45. Bhandari N., Bahl R., Taneja S. et al. Substantial reduction in severe diarrheal morbidity by daily zinc supplementation in young north Indian children. Pediatrics. 2002; 109: E86.


Review

For citations:

Lind T., Lonnerdal B., Stenlund H., Gamayanti I., Ismail D., Seswandhana R., Persson L. A COMMUNITY BASED RANDOMIZED CONTROLLED TRIAL OF IRON AND ZINC SUPPLEMENTATION IN INFANTS: EFFECTS ON GROWTH AND DEVELOPMENT. Current Pediatrics. 2006;5(6):45-54.

Views: 3586


ISSN 1682-5527 (Print)
ISSN 1682-5535 (Online)

"Paediatrician" Publishers LLC
Unit 4/1, 54–4 Vavilova Street, 119296, Moscow, Russian Federation
Web-site: http://www.spr-journal.ru/
E-mail: vsp@spr-journal.ru
Tel.: +7 (499) 132-02-17
Мob.: +7 (916) 650-07-42

Яндекс.Метрика

Processing of personal data
supported by NEICON (Elpub lab)