Effects of separate delivery of zinc or zinc and vitamin A on hemoglobin response, growth, and diarrhea in young Peruvian children receiving iron therapy for anemia

• Published in: The American journal of clinical nutrition 2004-11, Vol.80 (5), p.1276-1282
• Main Authors: Alarcon, K, Kolsteren, P.W, Prada, A.M, Chian, A.M, Velarde, R.E, Pecho, I.L, Hoeree, T.F
• Format: Article
• Language: English
• Subjects: Anemia; Anemia, Iron-Deficiency - drug therapy; Anemia, Iron-Deficiency - epidemiology; Biological and medical sciences; Child, Preschool; Children & youth; Diarrhea; Diarrhea - drug therapy; Diarrhea - epidemiology; Double-Blind Method; Drug Therapy, Combination; Feeding. Feeding behavior; Female; Ferrous Compounds - therapeutic use; Fundamental and applied biological sciences. Psychology; Hemoglobin; Hemoglobins - drug effects; Humans; Infant; Iron; Male; Malnutrition; Peru - epidemiology; Physical growth; Prevalence; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin A; Vitamin A - administration & dosage; Vitamin A - therapeutic use; Zinc; Zinc Sulfate - administration & dosage; Zinc Sulfate - therapeutic use
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/80.5.1276

Introduction: Anemia is the most prevalent nutritional deficiency in the world. Attempts to improve iron indexes are affected by deficiency of and interaction between other micronutrients. Objective: Our goal was to assess whether zinc added to iron treatment alone or with vitamin A improves iron indexes and affects diarrheal episodes. Design: This was a randomized, placebo-controlled, double-blind trial conducted in Peru. Anemic children aged 6-35 mo were assigned to 3 treatment groups: ferrous sulfate (FS; n = 104), ferrous sulfate and zinc sulfate (FSZn; n = 109), and ferrous sulfate, zinc sulfate, and vitamin A (FSZnA; n = 110). Vitamin A or its placebo was supplied only once; iron and zinc were provided under supervision greater than or equal to 1 h apart 6 d/wk for 18 wk. Results: The prevalence of anemia was 42.97%. The increase in hemoglobin in the FS group (19.5 g/L) was significantly less than that in the other 2 groups (24.0 and 23.8 g/L in the FSZn and FSZnA groups, respectively). The increase in serum ferritin in the FS group (24.5 microgram/L) was significantly less than that in the other 2 groups (33.0 and 30.8 microgram/L in the FSZn and FSZnA groups, respectively). The median duration of diarrhea and the mean number of stools per day was significantly higher in the FS group than in other 2 groups (P < 0.005). Conclusion: Adding zinc to iron treatment increases hemoglobin response, improves iron indexes, and has positive effects on diarrhea. No additional effect of vitamin A was found.