ZINC AND REHABILITATION FROM SEVERE PROTEIN-ENERGY MALNUTRITION - HIGHER-DOSE REGIMENS ARE ASSOCIATED WITH INCREASED MORTALITY

A randomized, double-blind trial was undertaken to measure the effects of zinc supplementation on catch-up growth in severe protein-energy m alnutrition, with particular reference to linear growth. One hundred f orty-one children between the ages of 6 mo and 3 y were enrolled after admission to a nutritional rehabilitation unit in Dhaka, Bangladesh, and randomly assigned to receive elemental zinc by mouth, 1.5 mg/kg fo r 15 d, 6.0 mg/kg for 15 d, or 6.0 mg/kg for 30 d, and thereafter they were followed for a total of 90 d. Anthropometric outcome measures in cluded change in knee-heel length, midupper arm circumference, subscap ular and triceps skinfold thicknesses, and change in height-for-age, w eight-for-age, and weight-for-height z scores. Higher zinc doses were not associated with significant change in any anthropometric measureme nt, but mortality was significantly greater in children who received h igh-dose zinc (6.0 mg/kg) initially as opposed to those who received l ow-dose zinc supplementation (1.5 mg/kg) (Yates-corrected chi-square P value of 0.033 and a risk ratio of 4.53: 95% CI: 1.09 < risk ratio < 18.8). We conclude that there is no benefit to using high-dose zinc su pplementation regimens and that they could contribute to increased mor tality in severely malnourished children.