Effects of Zinc and Multivitamins Supplements on growth in School Children: Zinc and Multivitamins Supplements on growth in School Children

Junaid  Ghaffar; Muhammad  Uzair; Zahid  Mahmood; Riffat  Farrukh; Shaheen  Masood; Qamar  Rizvi

doi:10.54393/pjhs.v3i04.121

Authors

Junaid Ghaffar Department of Pediatrics, Sialkot Medical College, Sialkot
Muhammad Uzair Department Pediatrics. Sahara Medical College, Narowal
Zahid Mahmood Department Pediatrics, Shaikh Zayed Hospital, Rahim Yar Khan
Riffat Farrukh Department, Department of Pediatrics, Karachi Medical and Dental College and Abbasi Shaheed Hospital
Shaheen Masood Department Pediatrics, Karachi Medical and Dental College
Qamar Rizvi Department of Pharmacology, Hamdard University, Karachi

DOI:

https://doi.org/10.54393/pjhs.v3i04.121

Keywords:

Multivitamins, Dietary supplements, child, growth and zinc

Abstract

Zinc and many vitamins are important for development. Various vitamins and zinc deficiencies are communal in emerging states. Objective: The purpose of this anlaysis was to evaluate the effectiveness of multivitamin supplementation with zinc in enhancing the schoolchildren growth. Methods: Children aged 5-15 attending a public school were included. 160 participants were randomised to take multivitamins (200 IU vitamin D, 1,000 IU vitamin A, 10 mg B1, 1 mg B6, 3 mg B2, nicotinamide 40mg, B12 10 mcg) along with zinc chelated zinc glycinate (20 mg elemental zinc) or once daily placebo treatment was given for 5 days in a week for six-months. The height change from reference value was the primary outcome which was taken significant till conclusion of the analysis. The outcomes which were secondary were variations in BMI, body weight, hip and waist circumference, and ratio of waist-to-height. An intent to treat analysis was accomplished. Results: 80 children were randomly assigned to the control group or 80 in the treatment groups. Children who took multivitamins along with zinc had a greater height increase ((4.5±5.1 vs 3.5±4.1 cm, correspondingly; 0.001 of P value). Subgroup analysis exhibited substantial height improvement, particularly among preadolescents. The greatest increase in height occurred regardless of the initial weight and height. An additional increase in growth is visible subsequently two months of supplement. Variations in the other anthropometrical measures did not differ substantially. Conclusions: 6-month supplementation with zinc chelated and multivitamins significantly increase height among school going children and was better endured.

References

Carrero C, Leal J, Ortega P, Parody A, Montilla M, Sierra L, Viloria A, Borrero TC, Varela N. Effect of Vitamin A, Zinc and multivitamin supplementation on the nutritional status and retinol serum values in school-age children. InInternational Conference on Data Mining and Big Data 2018 Jun 17 (pp. 748-758). Springer, Cham.

Carter RC, Kupka R, Manji K, McDonald CM, Aboud S, Erhardt JG, Gosselin K, Kisenge R, Liu E, Fawzi W, Duggan CP. Zinc and multivitamin supplementation have contrasting effects on infant iron status: a randomized, double-blind, placebo-controlled clinical trial. European journal of clinical nutrition. 2018 Jan;72(1):130-5.

Kumar S, Palve A, Joshi C, Srivastava RK. Crop biofortification for iron (Fe), zinc (Zn) and vitamin A with transgenic approaches. Heliyon. 2019 Jun 1;5(6):e01914.

Lam LF, Lawlis TR. Feeding the brain–The effects of micronutrient interventions on cognitive performance among school-aged children: A systematic review of randomized controlled trials. Clinical Nutrition. 2017 Aug 1;36(4):1007-14.

Zysk B, Stefanska E, Ostrowska L. Effect of dietary components and nutritional status on the development of pre-school children. Roczniki Państwowego Zakładu Higieny. 2020;71(4).

Sudfeld CR, Manji KP, Darling AM, Kisenge R, Kvestad I, Hysing M, Belinger DC, Strand TA, Duggan CP, Fawzi WW. Effect of antenatal and infant micronutrient supplementation on middle childhood and early adolescent development outcomes in Tanzania. European journal of clinical nutrition. 2019 Sep;73(9):1283-90.

Blumberg JB, Cena H, Barr SI, Biesalski HK, Dagach RU, Delaney B, Frei B, González MI, Hwalla N, Lategan-Potgieter R, McNulty H. The use of multivitamin/multimineral supplements: a modified delphi consensus panel report. Clinical therapeutics. 2018 Apr 1;40(4):640-57.

Adu‐Afarwuah S, Lartey A, Dewey KG. Meeting nutritional needs in the first 1000 days: A place for small‐quantity lipid‐based nutrient supplements. Annals of the New York Academy of Sciences. 2017 Mar;1392(1):18-29.

Rodríguez-Carmona Y, Denova-Gutiérrez E, Sánchez-Uribe E, Muñoz-Aguirre P, Flores M, Salmerón J. Zinc supplementation and fortification in Mexican children. Food and nutrition bulletin. 2020 Mar;41(1):89-101.

Marra MV, Bailey RL. Position of the Academy of Nutrition and Dietetics: micronutrient supplementation. Journal of the Academy of Nutrition and Dietetics. 2018 Nov 1;118(11):2162-73.

Liu H, Zhang S, Zou H, Pan Y, Yang Q, Ouyang Y, Luo J, Lin Q. Dietary supplement use among chinese primary school students: A cross-sectional study in hunan province. International Journal of Environmental Research and Public Health. 2019 Feb;16(3):374.

De‐Regil LM, Jefferds ME, Peña‐Rosas JP. Point‐of‐use fortification of foods with micronutrient powders containing iron in children of preschool and school‐age. Cochrane Database of Systematic Reviews. 2017(11).

Cho JM, Kim JY, Yang HR. Effects of oral zinc supplementation on zinc status and catch-up growth during the first 2 years of life in children with non-organic failure to thrive born preterm and at term. Pediatrics & Neonatology. 2019 Apr 1;60(2):201-9.

Castro LC, Costa NM, Sant’Anna HM, Ferreira CL, Franceschini SD. Improvement the nutritional status of pre-school children following intervention with a supplement containing iron, zinc, copper, vitamin A, vitamin C and prebiotic. Ciência & Saúde Coletiva. 2017;22:359-68.

Suchdev PS, Jefferds ME, Ota E, da Silva Lopes K, De‐Regil LM. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane database of systematic reviews. 2020(2).

Bharadva K, Mishra S, Tiwari S, Yadav B, Deshmukh U, Elizabeth KE, Banapurmath CR. Prevention of micronutrient deficiencies in young children: consensus statement from infant and young child feeding chapter of Indian Academy of Pediatrics. Indian pediatrics. 2019 Jul;56(7):577-86.

Campbell RK, Hurley KM, Shamim AA, Shaikh S, Chowdhury ZT, Mehra S, Wu L, Christian P. Complementary food supplements increase dietary nutrient adequacy and do not replace home food consumption in children 6–18 months old in a randomized controlled trial in rural Bangladesh. The Journal of nutrition. 2018 Sep 1;148(9):1484-92.

Oh C, Keats EC, Bhutta ZA. Vitamin and mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low-and middle-income countries: a systematic review and meta-analysis. Nutrients. 2020 Feb 14;12(2):491.

Kusumastuti AC, Ardiaria M, Hendrianingtyas M. Effect of zinc and iron supplementation on appetite, nutritional status and intelligence quotient in young children. The Indonesian Biomedical Journal. 2018 Aug 2;10(2):133-9.

Wang AZ, Shulman RJ, Crocker AH, Thakwalakwa C, Maleta KM, Devaraj S, Manary MJ, Trehan I. A combined intervention of zinc, multiple micronutrients, and albendazole does not ameliorate environmental enteric dysfunction or stunting in rural Malawian children in a double-blind randomized controlled trial. The Journal of nutrition. 2017 Jan 1;147(1):97-103.

Calder PC, Carr AC, Gombart AF, Eggersdorfer M. Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients. 2020 Apr 23;12(4):1181.

Sudargo T, Muhammad HF, Kandarina I, Putri N, Irianto SE, Pranoto YA, Paramastri R. The effect of additional egg supplementation on vitamin and mineral fortification program on growth, cognitive development and hemoglobin in Indonesian underweight and stunting children. Nutrition & Food Science. 2018 Jun 21.

Paganini D, Zimmermann MB. The effects of iron fortification and supplementation on the gut microbiome and diarrhea in infants and children: a review. The American journal of clinical nutrition. 2017 Dec 1;106(suppl_6):1688S-93S.

Millward DJ. Nutrition, infection and stunting: the roles of deficiencies of individual nutrients and foods, and of inflammation, as determinants of reduced linear growth of children. Nutrition research reviews. 2017 Jun;30(1):50-72.

Vaivada T, Gaffey MF, Das JK, Bhutta ZA. Evidence-based interventions for improvement of maternal and child nutrition in low-income settings: what's new?. Current opinion in clinical nutrition and metabolic care. 2017 May 1;20(3):204-10.

French B, Outhwaite LA, Langley‐Evans SC, Pitchford NJ. Nutrition, growth, and other factors associated with early cognitive and motor development in Sub‐Saharan Africa: a scoping review. Journal of Human Nutrition and Dietetics. 2020 Oct;33(5):644-69.

Mispireta ML, Caulfield LE, Zavaleta N, Merialdi M, Putnick DL, Bornstein MH, DiPietro JA. Effect of maternal zinc supplementation on the cardiometabolic profile of Peruvian children: results from a randomized clinical trial. Journal of developmental origins of health and disease. 2017 Feb;8(1):56-64.

Roberts JL, Stein AD. The impact of nutritional interventions beyond the first 2 years of life on linear growth: a systematic review and meta-analysis. Advances in Nutrition. 2017 Mar;8(2):323-36.

Bailey RL, Catellier DJ, Jun S, Dwyer JT, Jacquier EF, Anater AS, Eldridge AL. Total usual nutrient intakes of US children (under 48 months): findings from the Feeding Infants and Toddlers Study (FITS) 2016. The Journal of nutrition. 2018 Sep 1;148(suppl_3):1557S-66S.

Sharif Y, Sadeghi O, Dorosty A, Siassi F, Jalali M, Djazayery A, Shokri A, Mohammad K, Parsaeian M, Abdollahi Z, Heshmat R. Association of vitamin D, retinol and zinc deficiencies with stunting in toddlers: findings from a national study in Iran. Public health. 2020 Apr 1;181:1-7.