Randomized, community-based trial of the effect of zinc supplementation, with and without other micronutrients, on the duration of persistent childhood diarrhea Lima, Peru

Objective: To determine whether supplemental zinc, with or without addition al micronutrients, affects the severity and duration of persistent childhoo d diarrhea and the rate of nutritional recovery. Design: The study was a community-based, double-blind, randomized trial imp lemented in a shanty town in Lima, Peru. Children aged 6 to 36 months with persistent (greater than or equal to 14 days) diarrhea received daily, for 2 weeks, a placebo (group P, n = 136) or a supplement of 20 mg of zinc, eit her with (group Z+VM, n = 137) or without (group Z, n = 139) additional vit amins and minerals. Symptoms of illness were recorded daily, and biochemica l and anthropometric assessments were completed at baseline and on day 15. Results: The treatment groups were similar at baseline with regard to the c haracteristics of the presenting episode, anthropometric data, and plasma z inc concentration. The children consumed, on average, 95% (group P), 94% (g roup Z), or 88% (group Z+VM) of the supplement (P < .001). The plasma zinc concentration did not change significantly from baseline to day 15 in group P (4 mu g/dL) but increased by 38 mu g/dL in group Z and 14 mu g/dL in gro up Z+VM. The median duration of diarrhea after starting treatment was 1 day ; among children who continued to have diarrhea, there was a significant ef fect of treatment on diarrheal duration (P = .04, analysis of covariance). Specifically, the duration of illness was significantly reduced by 28% in c hildren in group Z (P = .01) and by 33% in girls in group Z+VM (P = .04). T here were no differences in the severity of the episode by treatment group. Conclusion: There was a significant reduction in the duration of persistent diarrhea in selected subgroups of zinc-supplemented ambulatory patients in this population.