Reduced serum zinc levels while improving growth of underweight school children in trial of zinc-fortified milk in Indonesia
Keywords:
zinc fortification, zinc serum, growth, underweight, school children
Abstract
Background Most children in low-income countries haveinadequate dietary zinc. The study was aimed to demonstrate the
effect of iron-zinc fortified milk in improving zinc status among
underweight school children in Indonesia.
Objective To evaluate the effects of milk fortification with zinc on
serum zinc levels in underweight Indonesian school children.
Methods A double-blind, randomized, controlled, communitybased
study was conducted on 426 underweight children aged 7
to 9 years in several low economic income level elementary schools
in Jakarta and Solo. Subjects were randomly allocated to receive
either zinc-fortified milk (n= 217) or standard milk (n=209) for
6 months. The fortified milk provided an 2.38 mg zinc per day
and the standard milk provided 0.88 mg zinc per day.
Results Among underweight children, the prevalence of stunting
with a height-for-age z-score < - 2.0 SD was 39.7%. Almost all
subjects (98%) had zinc intake ofless than 60% of the Indonesian
recommended daily allowance (RDA) for that particular age
group. After receiving the milk intervention, mean serum zinc
concentration declined significantly in both groups (from 13 .50
±3.05 μmol/Lat baseline to 10.59±1.93 μmol/L, P< 0.05), but
growth parameters (weight and height) improved.
Conclusion Reduced mean serum zinc levels were observed in
children who received standard milk, as well as those who received
zinc-fortified milk. These reduction in serum zinc levels may be a
part of homeostatic control mechanim for improving the negative
zinc balance in zinc pools, as a negative effect on linear growth
was not observed. Larger clinical trials of adequate sample size
need to be conducted in order to provide better understanding
on zinc regulation among underweight school children. [Paediatr
lndones. 2012;52:118-24).
References
1. International Zinc Nutrition Consultative Group
(IZiNCG), Brown KH, Rivera JA, Bhutta Z, Gibson RS,
King JC, et al. Assessment of the risk of zinc deficiency in
populations and options for its control. Food Nutt Bull.
2004;25:899-203.
2. Hambidge KM. Human zinc deficiency. J Nutr. 2000;
130:1344-9.
3. 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: 1062-71.
4. Bhutta ZA, Bird SM, Black RE, Brown KH, Gardner JM,
Hidayat A, et al. Therapeutic effects of oral zinc in acute
and persistent diarrhea in children in developing countries:
pooled analysis of randomized controlled trials. Am J Chn
Nutt. 2000;72:1516-22.
5. International Zinc Nutrition Consultative Group (IZiNCG).
Assessing population zinc status with serum zinc concentration.
IZiNCGTechnical Brief No. 2. Davis, CA: IZiNCG; 2007.
6. International Zinc Nutrition Consultative Group (IZiNCG).
Determining the prevalence of zinc deficiency: assessment
of dietary zinc intake. IZiNCG Technical Brief No. 3. Davis,
CA: IZiNCG, 2007.
7. Hess SY, Brown KH. Impact of zinc fortification on zinc
nutrition. Food Nutt Bull. 2009;30:79-107.
8. King JC, Shames DM, Woodhouse LR. Zinc homeostasis in
humans. J Nutr. 2000;130:1360-6.
9. Manary MJ, Hotz C, Krebs NF, Gibson RS, Westcott JE,
Broadhead RL. Zinc homeostasis in Malawian children
consuming a high-phytate, maize-based diet. Am J Clin
Nutr. 2002;75:1057-61.
10. Hambidge M. Underwood Memorial Lecture: human zinc
homeostasis: good but not perfect. J Nutt. 2003; 133:1438-
42.
11. King JC, Shames DM, Lowe NM, Woodhouse LR, Sutherland
B, Abrams SA, et al. Effect of acute zinc depletion on zinc
homeostasis and plasma zinc kinetics in men. Am J Clin
Nutr. 2001;74: 116-24.
12. Johnson PE, Hunt CD, Milne DB, Mullen LK. Homeostatic
control of zinc metabolism in men: zinc excretion and
balance in men fed diets low in zinc. Am J Clin Nutt.
1993;57 :557-65.
13. Sian L, Mingyan X, Miller LV, Tong L, Krebs NF, Hambidge
KM. Zinc absorption and intestinal losses of endogenous
zinc in young Chinese women with marginal zinc intakes.
Am J Chn Nutr. 1996;63:348-53.
14. Lestari ED, Badarsono S, Lestarina L, Salimo H. Effect
of ironzinc fortified milk on iron status and functional
outcomes in underweight children. Paediatr Indones.
2009;49:139-48.
15. Lonnerdal B, Cederblad A, Davidsson L, Sandstrom B.
The effect of individual components of soy formula and
cows' milk formula on zinc bioavailability. Am J Clin Nutt.
1984;40:1064-70.
16. Hotz C, Peerson JM, Brown KH. Suggested lower cutoffs
of serum zinc concentrations for assessing zinc status:
reanalysis of the second National Health and Nutrition
Examination Survey data (1976-1980). Am J Clin Nutt.
2003;78:756-64.
17. Hess SY, Peerson JM, King JC, Brown KH. Use of serum
zinc concentration as an indicator of population zinc status.
Food Nutr Bull. 2007;28:403-29.
18. Brown KH. Effect of infections on plasma zinc concentration
and implications for zinc status assessment in low-income
countries. AmJ Clin Nutr. 1998;68:425-9.
19. Ohiokpehai 0, David DM, Kamau]. Serum zinc levels of
school children on a com-soy blend feeding trial in primary
schools in Suba district, Kenya. J Appl Biosci. 2009; 17 :904-
12.
20. Pinna K, Woodhouse LR, Sutherland B, Shames DM,
King JC. Exchangeable zinc pool masses and turnover are
maintained in healthy men with low zinc intakes. J Nutt.
2001;13 l :2288-94.
(IZiNCG), Brown KH, Rivera JA, Bhutta Z, Gibson RS,
King JC, et al. Assessment of the risk of zinc deficiency in
populations and options for its control. Food Nutt Bull.
2004;25:899-203.
2. Hambidge KM. Human zinc deficiency. J Nutr. 2000;
130:1344-9.
3. 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: 1062-71.
4. Bhutta ZA, Bird SM, Black RE, Brown KH, Gardner JM,
Hidayat A, et al. Therapeutic effects of oral zinc in acute
and persistent diarrhea in children in developing countries:
pooled analysis of randomized controlled trials. Am J Chn
Nutt. 2000;72:1516-22.
5. International Zinc Nutrition Consultative Group (IZiNCG).
Assessing population zinc status with serum zinc concentration.
IZiNCGTechnical Brief No. 2. Davis, CA: IZiNCG; 2007.
6. International Zinc Nutrition Consultative Group (IZiNCG).
Determining the prevalence of zinc deficiency: assessment
of dietary zinc intake. IZiNCG Technical Brief No. 3. Davis,
CA: IZiNCG, 2007.
7. Hess SY, Brown KH. Impact of zinc fortification on zinc
nutrition. Food Nutt Bull. 2009;30:79-107.
8. King JC, Shames DM, Woodhouse LR. Zinc homeostasis in
humans. J Nutr. 2000;130:1360-6.
9. Manary MJ, Hotz C, Krebs NF, Gibson RS, Westcott JE,
Broadhead RL. Zinc homeostasis in Malawian children
consuming a high-phytate, maize-based diet. Am J Clin
Nutr. 2002;75:1057-61.
10. Hambidge M. Underwood Memorial Lecture: human zinc
homeostasis: good but not perfect. J Nutt. 2003; 133:1438-
42.
11. King JC, Shames DM, Lowe NM, Woodhouse LR, Sutherland
B, Abrams SA, et al. Effect of acute zinc depletion on zinc
homeostasis and plasma zinc kinetics in men. Am J Clin
Nutr. 2001;74: 116-24.
12. Johnson PE, Hunt CD, Milne DB, Mullen LK. Homeostatic
control of zinc metabolism in men: zinc excretion and
balance in men fed diets low in zinc. Am J Clin Nutt.
1993;57 :557-65.
13. Sian L, Mingyan X, Miller LV, Tong L, Krebs NF, Hambidge
KM. Zinc absorption and intestinal losses of endogenous
zinc in young Chinese women with marginal zinc intakes.
Am J Chn Nutr. 1996;63:348-53.
14. Lestari ED, Badarsono S, Lestarina L, Salimo H. Effect
of ironzinc fortified milk on iron status and functional
outcomes in underweight children. Paediatr Indones.
2009;49:139-48.
15. Lonnerdal B, Cederblad A, Davidsson L, Sandstrom B.
The effect of individual components of soy formula and
cows' milk formula on zinc bioavailability. Am J Clin Nutt.
1984;40:1064-70.
16. Hotz C, Peerson JM, Brown KH. Suggested lower cutoffs
of serum zinc concentrations for assessing zinc status:
reanalysis of the second National Health and Nutrition
Examination Survey data (1976-1980). Am J Clin Nutt.
2003;78:756-64.
17. Hess SY, Peerson JM, King JC, Brown KH. Use of serum
zinc concentration as an indicator of population zinc status.
Food Nutr Bull. 2007;28:403-29.
18. Brown KH. Effect of infections on plasma zinc concentration
and implications for zinc status assessment in low-income
countries. AmJ Clin Nutr. 1998;68:425-9.
19. Ohiokpehai 0, David DM, Kamau]. Serum zinc levels of
school children on a com-soy blend feeding trial in primary
schools in Suba district, Kenya. J Appl Biosci. 2009; 17 :904-
12.
20. Pinna K, Woodhouse LR, Sutherland B, Shames DM,
King JC. Exchangeable zinc pool masses and turnover are
maintained in healthy men with low zinc intakes. J Nutt.
2001;13 l :2288-94.
Published
2012-04-30
How to Cite
1.
Lestari E, Lilisianawati L, Bardosono S, Lestarina L, Salimo H. Reduced serum zinc levels while improving growth of underweight school children in trial of zinc-fortified milk in Indonesia. PI [Internet]. 30Apr.2012 [cited 6May2024];52(2):118-24. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/330
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Received 2016-08-22
Accepted 2016-08-22
Published 2012-04-30
Accepted 2016-08-22
Published 2012-04-30
