Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2017

Open Access 01-12-2017 | Research article

Small-quantity lipid-based nutrient supplements containing different amounts of zinc along with diarrhea and malaria treatment increase iron and vitamin A status and reduce anemia prevalence, but do not affect zinc status in young Burkinabe children: a cluster-randomized trial

Authors: Souheila Abbeddou, Elizabeth Yakes Jimenez, Jérome W. Somé, Jean Bosco Ouédraogo, Kenneth H. Brown., Sonja Y. Hess

Published in: BMC Pediatrics | Issue 1/2017

Login to get access

Abstract

Background

We assessed the effects of providing a package of interventions including small-quantity lipid-based nutrient supplements (SQ-LNS) containing 0, 5 or 10 mg zinc and illness treatment to Burkinabe children from 9 to 18 months of age, on biomarkers of zinc, iron and vitamin A status at 18 months and compared with a non-intervention cohort (NIC).

Methods

Using a two-stage cluster randomized trial design, communities were randomly assigned to the intervention cohort (IC) or NIC, and extended family compounds within the IC were randomly assigned to different treatment groups. IC children (n = 2435) were provided with 20 g SQ-LNS/d containing 0, 5 or 10 mg zinc, 6 mg of iron and 400 μg of vitamin A along with malaria and diarrhea treatment. NIC children (n = 785) did not receive the intervention package. At 9 and 18 months, hemoglobin (Hb), zinc, iron and vitamin A status were assessed in a sub-group (n = 404). Plasma concentrations of zinc (pZC), ferritin (pF), soluble transferrin receptor (sTfR) and retinol-binding protein (RBP) were adjusted for inflammation.

Results

At baseline, 35% of children had low adjusted pZC (<65 μg/dL), 93% were anemic (Hb <110 g/L), 25% had low adjusted pF (<12 μg/L), 90% had high adjusted sTfR (>8.3 mg/L) and 47% had low adjusted RBP (<0.94 μmol/L), with no group-wise differences. Compared with the NIC, at 18 months IC children had significantly lower anemia prevalence (74 vs. 92%, p = 0.001) and lower iron deficiency prevalence (13% vs. 32% low adjusted pF and 41% vs. 71% high adjusted sTfR, p < 0.001), but no difference in pZC. Mean adjusted RBP was greater at 18 months in IC vs. NIC (0.94 μmol/L vs. 0.86 μmol/L, p = 0.015), but the prevalence of low RBP remained high in both cohorts. Within the IC, different amounts of zinc had no effect on the prevalence of low pZC or indicators of vitamin A deficiency, whereas children who received SQ-LNS with 10 mg zinc had a significantly lower mean pF at 18 months compared to children who received SQ-LNS with 5 mg zinc (p = 0.034).

Conclusions

SQ-LNS regardless of zinc amount and source provided along with illness treatment improved indicators of iron and vitamin A status, but not pZC.

Trial registration

NCT00944281 (July 21, 2009).
Literature
1.
Black RE. Micronutrient deficiency: an underlying cause of morbidity and mortality. Bull World Health Organ. 2003;81:79.PubMedPubMedCentral
2.
Black RE. Global distribution and disease burden related to micronutrient deficiencies. Nestle Nutr Inst Workshop Ser. 2014;78:21–8.CrossRefPubMed
3.
Mayo-Wilson E, Imdad A, Herzer K, Yakoob MY, Bhutta ZA. Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis. BMJ. 2011;343:d5094.CrossRefPubMedPubMedCentral
4.
Brown KH, Rivera JA, Bhutta Z, Gibson RS, King JC, Lonnerdal B, Ruel MT, Sandtrom B, Wasantwisut E, Hotz C. International Zinc Nutrition Consultative Group (IZiNCG) technical document #1. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull. 2004;25(1):S99–S203.CrossRefPubMed
5.
Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–77.CrossRefPubMed
6.
Wessells K, Brown K. Estimating the global prevalence of zinc deficiency: results based on zinc availability in national food supplies and the prevalence of stunting. PLoS One. 2012;7(11):e50568.CrossRefPubMedPubMedCentral
7.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.CrossRefPubMed
8.
World Health Organisation. Global prevalence of vitamin A deficiency in populations at risk 1995–2005: WHO Global Database on Vitamin A Deficiency. Geneva: WHO; 2009.
9.
Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database Syst Rev. 2010;(12):Cd008524.
10.
Brown KH, Peerson JM, Baker SK, Hess SY. Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull. 2009;30(1):S12–40.CrossRefPubMed
11.
Fischer Walker C, Kordas K, Stoltzfus RJ, Black RE. Interactive effects of iron and zinc on biochemical and functional outcomes in supplementation trials. Am J Clin Nutr. 2005;82(1):5–12.PubMed
12.
Christian P, West Jr KP. Interactions between zinc and vitamin A: an update. Am J Clin Nutr. 1998;68(2):S435–S41.
13.
Sazawal S, Dhingra U, Deb S, Bhan MK, Menon VP, Black RE. Effect of zinc added to multi-vitamin supplementation containing low-dose vitamin A on plasma retinol level in children--a double-blind randomized, controlled trial. J Health Popul Nutr. 2007;25(1):62–6.PubMedPubMedCentral
14.
Rahman MM, Wahed MA, Fuchs GJ, Baqui AH, Alvarez JO. Synergistic effect of zinc and vitamin A on the biochemical indexes of vitamin A nutrition in children. Am J Clin Nutr. 2002;75(1):92–8.PubMed
15.
Arimond M, Zeilani M, Jungjohann S, Brown KH, Ashorn P, Allen LH, Dewey KG. Considerations in developing lipid-based nutrient supplements for prevention of undernutrition: experience from the International Lipid-Based Nutrient Supplements (iLiNS) Project. Matern Child Nutr. 2013;6(10):12049.
16.
Iannotti LL, Dulience SJ, Green J, Joseph S, Francois J, Antenor ML, Lesorogol C, Mounce J, Nickerson NM. Linear growth increased in young children in an urban slum of Haiti: a randomized controlled trial of a lipid-based nutrient supplement. Am J Clin Nutr. 2014;99(1):198–208.CrossRefPubMed
17.
Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin S, Briend A, Dewey KG. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Am J Clin Nutr. 2007;86(2):412–20.PubMed
18.
Lin CA, Manary MJ, Maleta K, Briend A, Ashorn P. An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6–18 months. J Nutr. 2008;138(3):593–8.PubMed
19.
Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin S, Briend A, Dewey KG. Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. Am J Clin Nutr. 2008;87(4):929–38.PubMed
20.
Siega-Riz AM, Estrada Del Campo Y, Kinlaw A, Reinhart GA, Allen LH, Shahab-Ferdows S, Heck J, Suchindran CM, Bentley ME. Effect of supplementation with a lipid-based nutrient supplement on the micronutrient status of children aged 6–18 months living in the rural region of Intibuca, Honduras. Paediatr Perinat Epidemiol. 2014;13(10):12117.
21.
World Health Organization. Physical status: The use and interpretation of anthropometry. In: Technical Report Series No. 854. Geneva: World Health Organization; 1995.
22.
Hess SY, Abbeddou S, Jimenez EY, Somé JW, Vosti SA, Ouédraogo ZP, Guissou RM, Ouédraogo J-B, Brown KH. Small-quantity lipid-based nutrient supplements, regardless of their zinc content, increase growth and reduce the prevalence of stunting and wasting in young Burkinabe children: A cluster-randomized trial. PLoS One. 2015;10(3):e0122242.CrossRefPubMedPubMedCentral
23.
Somé JW, Abbeddou S, Yakes Jimenez E, Hess SY, Ouedraogo ZP, Guissou RM, Vosti SA, Ouedraogo JB, Brown KH. Effect of zinc added to a daily small-quantity lipid-based nutrient supplement on diarrhoea, malaria, fever and respiratory infections in young children in rural Burkina Faso: a cluster-randomised trial. BMJ Open. 2015;5(9):e007828.CrossRefPubMedPubMedCentral
24.
Abbeddou S, Hess SY, Yakes Jimenez E, Somé JW, Vosti SA, Guissou RM, Ouédraogo J-B, Brown KH. Comparison of methods to assess adherence to small-quantity lipid-based nutrient supplements (SQ-LNS) and dispersible tablets among young Burkinabé children participating in a community-based intervention trial. Matern Child Nutr. 2015;11(4):S90–S104.CrossRef
25.
Brown KH, Peerson JM, Rivera J, Allen LH. 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(6):1062–71.PubMed
26.
Hess SY, Yakes EJ, Abbeddou S, Peerson JM, Somé JW, Ouédraogo Z, Ouédraogo JB, Brown KH. Comparison of zinc protoporphyrin concentration in capillary whole blood and venous washed red blood cells among young Burkinabe children. FASEB. 2013;27:107.4.CrossRef
27.
28.
Wessells KR, Ouedraogo ZP, Rouamba N, Hess SY, Ouedraogo JB, Brown KH. Short-term zinc supplementation with dispersible tablets or zinc sulfate solution yields similar positive effects on plasma zinc concentration of young children in Burkina Faso: a randomized controlled trial. J Pediatr. 2012;160(1):129–35.CrossRefPubMed
29.
Erhardt JG, Estes JE, Pfeiffer CM, Biesalski HK, Craft NE. Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique. J Nutr. 2004;134(11):3127–32.PubMed
30.
Bieri JG, Tolliver TJ, Catignani GL. Simultaneous determination of alpha-tocopherol and retinol in plasma or red cells by high pressure liquid chromatography. Am J Clin Nutr. 1979;32(10):2143–9.PubMed
31.
Labbe RF, Dewanji A, McLaughlin K. Observations on the zinc protoporphyrin/heme ratio in whole blood. Clin Chem. 1999;45(1):146–8.PubMed
32.
Engle-Stone R, Haskell MJ, Ndjebayi AO, Nankap M, Erhardt JG, Gimou MM, Brown KH. Plasma retinol-binding protein predicts plasma retinol concentration in both infected and uninfected Cameroonian women and children. J Nutr. 2011;141(12):2233–41.CrossRefPubMed
33.
Thurnham DI, McCabe LD, Haldar S, Wieringa FT, Northrop-Clewes CA, McCabe GP. Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis. Am J Clin Nutr. 2010;92(3):546–55.CrossRefPubMed
34.
Cook JD, Flowers CH, Skikne BS. The quantitative assessment of body iron. Blood. 2003;101(9):3359–64.CrossRefPubMed
35.
36.
37.
Hastka J, Lasserre JJ, Schwarzbeck A, Strauch M, Hehlmann R. Washing erythrocytes to remove interferents in measurements of zinc protoporphyrin by front-face hematofluorometry. Clin Chem. 1992;38(11):2184–9.PubMed
38.
World Health Organisation Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization; 2006: 312.
39.
World Health Organisation. Indicators for assessing infant and young child feeding practices. Conclusions of a consensus meeting held 6–8 November 2007 in Washington D.C., USA. In: Part I: Definition. Geneva, Switzerland; 2008.
40.
de Benoist B, Darnton-Hill I, Davidsson L, Fontaine O, Hotz C. Conclusions of the Joint WHO/UNICEF/IAEA/IZiNCG Interagency Meeting on Zinc Status Indicators. Food Nutr Bull. 2007;28(3):S480–S4.CrossRefPubMed
41.
Brown KH, Lopez de Romana D, Arsenault JE, Peerson JM, Penny ME. Comparison of the effects of zinc delivered in a fortified food or a liquid supplement on the growth, morbidity, and plasma zinc concentrations of young Peruvian children. Am J Clin Nutr. 2007;85(2):538–47.PubMed
42.
Zlotkin S, Arthur P, Schauer C, Antwi KY, Yeung G, Piekarz A. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. J Nutr. 2003;133(4):1075–80.PubMed
43.
Troesch B, van Stuijvenberg ME, Smuts CM, Kruger HS, Biebinger R, Hurrell RF, Baumgartner J, Zimmermann MB. A micronutrient powder with low doses of highly absorbable iron and zinc reduces iron and zinc deficiency and improves weight-for-age Z-scores in South African children. J Nutr. 2011;141(2):237–42.CrossRefPubMed
44.
Dekker LH, Villamor E. Zinc supplementation in children is not associated with decreases in hemoglobin concentrations. J Nutr. 2010;140(5):1035–40.CrossRefPubMed
45.
46.
Lutter CK. Iron deficiency in young children in low-income countries and new approaches for its prevention. J Nutr. 2008;138(12):2523–28.CrossRefPubMed
47.
Somé J, Abbeddou S, Yakes Jimenez E, Hess S, Ouédraogo Z, Guissou R, Vosti S, Ouédraogo J, Brown K. Treated malaria does not affect physical growth and hemoglobin concentration of young children in Burkina Faso. FASEBJ. 2015;29:757.7.
48.
Stoltzfus RJ, Chwaya HM, Montresor A, Albonico M, Savioli L, Tielsch JM. Malaria, hookworms and recent fever are related to anemia and iron status indicators in 0- to 5-y old Zanzibari children and these relationships change with age. J Nutr. 2000;130(7):1724–33.PubMed
49.
Graham EA, Felgenhauer J, Detter JC, Labbe RF. Elevated zinc protoporphyrin associated with thalassemia trait and hemoglobin E. J Pediatr. 1996;129(1):105–10.CrossRefPubMed
50.
Crowell R, Ferris AM, Wood RJ, Joyce P, Slivka H. Comparative effectiveness of zinc protoporphyrin and hemoglobin concentrations in identifying iron deficiency in a group of low-income, preschool-aged children: practical implications of recent illness. Pediatrics. 2006;118(1):224–32.CrossRefPubMed
51.
Vogeser M, Jacob K, Zachoval R. Erythrocyte protoporphyrins in hepatitis C viral infection. Clin Biochem. 2000;33(5):387–91.CrossRefPubMed
52.
Beard J. Indiators of iron status of populations: free erythrocyte protoporphyrin and zinc protoporphyrin; serum and plasma iron, total iron binding capacity and transferrin receptor; and serum transferrin receptor. In: WHO C, editor. Assessing the iron status of populations. 2nd ed. Geneva: World Health Organization; 2007.
53.
Kuusipalo H, Maleta K, Briend A, Manary M, Ashorn P. Growth and change in blood haemoglobin concentration among underweight Malawian infants receiving fortified spreads for 12 weeks: a preliminary trial. J Pediatr Gastroenterol Nutr. 2006;43(4):525–32.CrossRefPubMed
54.
De-Regil LM, Suchdev PS, Vist GE, Walleser S, Pena-Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database Syst Rev. 2011(9):Cd008959.
55.
World Health Organisation. Guideline, World Health Organisation. Guideline: use of multiple micronutrient powders for home fortification of foods consumed by infants and children 6–23 months of age. Geneva: World Health Organization; 2011.
56.
Wessells KR, Hess SY, Ouédraogo ZP, Rouamba N, Ouédraogo J-B, Brown KH. Asymptomatic malaria infection affects the interpretation of biomarkers of iron and vitamin A status, even after adjusting for systemic inflammation, but does not affect plasma zinc concentrations among young children in Burkina Faso. J Nutr. 2014;144(12):2050–58.CrossRefPubMed
Metadata
Title
Small-quantity lipid-based nutrient supplements containing different amounts of zinc along with diarrhea and malaria treatment increase iron and vitamin A status and reduce anemia prevalence, but do not affect zinc status in young Burkinabe children: a cluster-randomized trial
Authors
Souheila Abbeddou
Elizabeth Yakes Jimenez
Jérome W. Somé
Jean Bosco Ouédraogo
Kenneth H. Brown.
Sonja Y. Hess
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2017
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-016-0765-9

Other articles of this Issue 1/2017

BMC Pediatrics 1/2017 Go to the issue

Case report

A case report of parapneumonic pleural effusion caused by Streptococcus pneumoniae serotype 19A in a child immunized with 13-valent conjugate pneumococcal vaccine

Research article

Gestational age and 1-year hospital admission or mortality: a nation-wide population-based study

Research article

Parental decision making involvement and decisional conflict: a descriptive study

Research article

Pediatric non-diabetic ketoacidosis: a case-series report

Technical advance

BMI-for-age graphs with severe obesity percentile curves: tools for plotting cross-sectional and longitudinal youth BMI data

Research article

Urinary Neutrophil Gelatinase-associated Lipocalin in the evaluation of Patent Ductus Arteriosus and AKI in Very Preterm Neonates: a cohort study