1. Bhandari N et al assessed the impact of 4 months of daily zinc supplementation on the incidence of severe and recurrent diarrhea in a double blinded randomized controlled trial (13). They found that incidence of diarrhea during follow-up was lower in the zinc supplemented group as compared with the placebo group as well as the there was decreased incidence of prolonged diarrhea in the zinc supplemented group (13). However, patients in the zinc group also had an increase in average number of days with vomiting [4.3 ± 5.8 days Vs 2.6 ± 3.9 days] (13).
2. Roy SK et al demonstrated in a randomized double blind controlled trial that children with diarrhea receiving zinc in addition to multivitamins had lesser stool output and shorter duration of diarrhea (4).
3. A study from India by Sazawal et al has shown a 7% reduction in the proportion of episodes lasting more than seven days if zinc supplementation was given within 3 days of the onset of diarrhea (14).
4. Another study from India has reported that children receiving 40 mg of elemental zinc daily during acute diarrhea responded with a shorter duration of diarrhea than a control group (15).
5. In Mexican preschool children, zinc supplementation reduced diarrheal morbidity (16).
6. In a study in Bangladesh, weekly zinc supplementation over a period of 1 year reported fewer incidents of pneumonia and diarrhea in the zinc group than the control group (17).
7. Bhatnagar et al demonstrated that zinc with oral rehydration therapy reduces stool output and duration of diarrhea in hospitalized children in a randomized controlled trial in 287 children (18).
8. In a study in Kolkata, India, zinc supplementation to low birth weight infants reported lesser diarrheal episodes [1.36 episodes per child per year Vs 1.93 episodes per child year] in the zinc supplemented group versus the placebo group suggesting a beneficial impact on the incidence of diarrhea among low birth weight infants (19).
9. In a study in Turkey, mean duration of diarrhea was shorter in the zinc supplemented group as compared to the placebo group (20).
10. Another study from India demonstrated that there was reduction in diarrheal morbidity in zinc supplemented group whether given daily or in a weekly schedule (21).

A double blind randomized controlled trial in India analysed efficacy of zinc fortified oral rehydration salts solution (ORS) as compared to ORS without zinc in 6 to 35 month old in 1219 children. Total number of stools was lower in the zinc – ORS group (rate ratio: 0.83; 95% Cl, 0.71-0.96) as well as there was less watery stools (odds ratio, 0.61; 95% Cl, 0.39-0.95) as compared to the control group. However, there was no significant effect on diarrheal duration. Children who received zinc syrup had lower diarrheal duration (relative hazard, 0.89; 95% Cl, 0.80-0.99) and decreased total stools (rate ratio, 0.73; 95% Cl, 0.70-0.77) than control children. (Ref: - Bahl R, Bhandari N, Saksena M et al. Efficacy of zinc fortified oral rehydration solution in 6 to 35 month old children with acute diarrhea. Journal Pediatr 2002;141:677-682).

  It has been found that these beneficial effects of zinc are not dependent upon the type of zinc salts (22). Also there is no added advantage when commonly used 20 mg of daily dose of elemental zinc is increased to 30-40 mg daily (23, 24). Also zinc fortified ORS does not seem have any additional benefit as compared to plain zinc preparations.

• Based on studies in India and other developing countries, there is sufficient evidence to recommend zinc in the treatment of acute diarrhea as adjunct to oral rehydration. However ORS remains the mainstay of therapy during acute diarrhea and zinc has an additional modest benefit in the reduction of stool volume and duration of diarrhea as an adjunct to ORS.
• A uniform dose of 20 mg of elemental zinc should be given during the period of diarrhea and for 7 days after cessation of diarrhea in children older than 3 months. Recommendations for below 3 months must await further research.

Zinc Investigators Collaborative Group (2000) (23) have also recommended zinc supplementation as part of routine, standard case management in persistent diarrhea and in those with severe malnutrition.

Cost-effectiveness of zinc supplementation as an adjunct therapy to diarrhea in children.
Robberstad B et al demonstrated that use of zinc as adjunct therapy significantly improved the cost-effectiveness of standard management of diarrhea with particular benefits in mortality rates in non-dysenteric diarrhea (27). References:

Last Created On 1/8/2006
Last Updated On 20/2/2007