1
|
Milani GP, Alberti I, Abodi M, Lakoumentas J, Konstantinou GN, Papadopoulos NG, Pop RM, Bocsan IC, Cassimos D, Kull I, Bettocchi S, Corsello A, Cugliari M, Ciliberti L, Spolidoro GCI, Agostoni C, Vlieg Boerstra B, Venter C, O'Mahony L, Vassilopoulou E. A systematic review and meta-analysis on nutritional and dietary interventions for the treatment of acute respiratory infection in pediatric patients: An EAACI taskforce. Allergy 2024; 79:1687-1707. [PMID: 38174413 DOI: 10.1111/all.15997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
Acute respiratory infections are a major cause of morbidity and mortality in children worldwide. Dietary and nutritional interventions, including minerals and vitamin supplementation, have been explored as potential treatments for these infections. However, the evidence on their efficacy is limited and inconclusive. This systematic review and meta-analysis aim to provide a comprehensive summary of the available evidence on the effectiveness of dietary and nutritional interventions for treating acute respiratory tract infections in children. A systematic review was conducted according to the PRISMA 2020 guidelines in April 2022 and updated in April 2023. Clinical trials focusing on dietary or nutritional interventions, including supplementations, in children with acute respiratory tract infections were included. The selection of interventions and outcomes was based on biological plausibility. Data were extracted using a standardized form, and the risk of bias was assessed using the Cochrane Risk of Bias Tool. Meta-analysis was performed using random-effect models. A total of 50 studies were included in the review. Four trials were conducted in low, 32 in lower-middle, 12 in upper-middle, and only two in high-income countries. The studies evaluated various dietary interventions, including zinc, vitamin A, vitamin E, vitamin D, and probiotics. The results of individual studies on the efficacy of these interventions were mixed, with some showing positive effects on clinical outcomes such as duration of symptoms, while others showed no significant impact. Meta-analysis was conducted for zinc supplementation in children with pneumonia, and the pooled results suggested a potential limited benefit in terms of reduced hospital length of stay but not time to recovery. Meta-analyses on vitamin D did not show any effect in children with pneumonia. This systematic review fills a critical gap in the literature by synthesizing the available evidence on the efficacy and safety of nutritional or dietary interventions for acute respiratory tract infections in children. The findings indicate no dietary or nutritional intervention can currently be recommended for the routine treatment of respiratory tract infections in children based on single supplement studies. The metanalysis suggests that zinc supplementation might have a beneficial effect on length of hospitalization in children with pneumonia. New studies are needed to establish more conclusive evidence for pediatric acute respiratory diseases especially for children living in a context of high-income countries.
Collapse
Affiliation(s)
- Gregorio P Milani
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Ilaria Alberti
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Abodi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - John Lakoumentas
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | | | - Raluca M Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ioana C Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dimitrios Cassimos
- Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Silvia Bettocchi
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Corsello
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Marco Cugliari
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Letizia Ciliberti
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Giulia C I Spolidoro
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Berber Vlieg Boerstra
- Department of Pediatrics, OLVG Hospital, Amsterdam, The Netherlands
- Rijnstate Allergy Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carina Venter
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Liam O'Mahony
- Department of Medicine and School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Emilia Vassilopoulou
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| |
Collapse
|
2
|
Li B, Wu G, Yang X, Li Z, Albasher G, Alsultan N, Memon AA, Afridi HI. Correlation of endocrine disrupting chemicals with essential elements in biological samples of children (1-5 years) with different infectious diseases and impact on sustainable outdoor activities. ENVIRONMENTAL RESEARCH 2023; 229:115781. [PMID: 37076035 DOI: 10.1016/j.envres.2023.115781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 05/03/2023]
Abstract
Endocrine disrupting chemicals (EDCs) have been extensively explored due to their harmful effects on individual health and the environment by interfering with hormone activity and disrupting the endocrine system. However, their relationship with essential trace elements remains uncertain. This research aimed to investigate the possible correlation between essential trace elements and toxic metals, including cadmium (Cd), and lead (Pb) in children aged 1-5 years with various infectious diseases, including gastrointestinal disorders, typhoid fever, and pneumonia. The study was conducted on biological testing and specimen (scalp hair and whole blood) of diseased and non-diseased children of the same residential area and referent/control age-matched children from developed cities consuming domestically treated water. The media of biological samples were oxidized by an acid mixture before being analyzed by atomic absorption spectrophotometry. The accuracy and validity of the methodology were verified through accredited reference material from scalp hair and whole blood sample. The study results revealed that diseased children had lower mean values of essential trace elements (iron, copper, and zinc) in both scalp hair and blood, except for copper, which was found to be higher in blood samples of diseased children. This implies that the deficiency of essential residue and trace elements in children from rural areas who consume groundwater is linked to various infectious diseases. The study highlights the need for more human biomonitoring of EDCs to better comprehend their non-classical toxic properties and their concealed costs on human health. The findings suggest that exposure to EDCs could be associated with unfavorable health outcomes and emphasizes the need for future regulatory policies to minimize exposure and safeguard the health of current and forthcoming generations of children. Furthermore, the study highlights the implication of essential trace elements in maintaining good health and their potential correlation with toxic metals in the environment.
Collapse
Affiliation(s)
- Bo Li
- Physical Education Department, Xi'an University of Finance and Economics, 64 Xiaozhai E Rd, Yanta District, Xi'An, Shaanxi, China
| | - Guangliang Wu
- Physical Education Department, Renmin University of China, No. 59, Zhongguancun Street, Haidian District, Beijing, China.
| | - Xiaoguang Yang
- Physical Education Department, Xi'an University of Finance and Economics, 64 Xiaozhai E Rd, Yanta District, Xi'An, Shaanxi, China
| | - Zeyun Li
- Geography Section, School of Humanities, Universiti Sains Malaysia, Penang, Malaysia
| | - Gadah Albasher
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Alsultan
- Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom
| | - Aijaz Ahmed Memon
- National Center of Excellence in Analytical Chemistry, University of Sindh, Jamshoro, 76080, Pakistan
| | - Hassan Imran Afridi
- National Center of Excellence in Analytical Chemistry, University of Sindh, Jamshoro, 76080, Pakistan
| |
Collapse
|
3
|
Zinc in Human Health and Infectious Diseases. Biomolecules 2022; 12:biom12121748. [PMID: 36551176 PMCID: PMC9775844 DOI: 10.3390/biom12121748] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
During the last few decades, the micronutrient zinc has proven to be an important metal ion for a well-functioning immune system, and thus also for a suitable immune defense. Nowadays, it is known that the main cause of zinc deficiency is malnutrition. In particular, vulnerable populations, such as the elderly in Western countries and children in developing countries, are often affected. However, sufficient zinc intake and homeostasis is essential for a healthy life, as it is known that zinc deficiency is associated with a multitude of immune disorders such as metabolic and chronic diseases, as well as infectious diseases such as respiratory infections, malaria, HIV, or tuberculosis. Moreover, the modulation of the proinflammatory immune response and oxidative stress is well described. The anti-inflammatory and antioxidant properties of zinc have been known for a long time, but are not comprehensively researched and understood yet. Therefore, this review highlights the current molecular mechanisms underlying the development of a pro-/ and anti-inflammatory immune response as a result of zinc deficiency and zinc supplementation. Additionally, we emphasize the potential of zinc as a preventive and therapeutic agent, alone or in combination with other strategies, that could ameliorate infectious diseases.
Collapse
|
4
|
Hume-Nixon M, Graham H, Russell F, Mulholland K, Gwee A. Review of the role of additional treatments including oseltamivir, oral steroids, macrolides, and vitamin supplementation for children with severe pneumonia in low- and middle-income countries. J Glob Health 2022; 12:10005. [PMID: 35993199 PMCID: PMC9393748 DOI: 10.7189/jogh.12.10005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Pneumonia is a major cause of death in children aged under five years. As children with severe pneumonia have the highest risk of morbidity and mortality, previous studies have evaluated the additional benefit of adjunctive treatments such as oseltamivir, oral steroids, macrolides, and vitamin supplementation that can be added to standard antibiotic management to improve clinical outcomes. The study reviewed the evidence for the role of these additional treatments for children with severe pneumonia in low- and middle-income countries (LMICs). Methods Four electronic databases were searched for English-language articles between 2000 to 2020. Systematic reviews (SRs) with meta-analyses, comparative cohort studies, and randomised controlled trials (RCTs) from LMICs that reported clinical outcomes for children with severe pneumonia aged between one month to 9 years who received adjunct treatment in addition to standard care were included. Risk of bias of included SRs was assessed using AMSTAR 2, and of individual studies using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Results Overall, the search identified 2147 articles, 32 of which were eligible, including 7 SRs and 25 RCTs. These studies evaluated zinc (4 SRs, 17 RCTs), Vitamin D (1 SR, 4 RCTs), Vitamin A (3 SRs, 1 RCT), Vitamin C (1 SR, 2 RCTs) and micronutrients (1 RCT). Most studies reported clinical outcomes of time to improvement, length of stay, and treatment failure (including mortality). No studies of oseltamivir, steroids, or macrolides fulfilling the inclusion criteria were identified. For zinc, pooled analyses from SRs showed no evidence of benefit. Similarly, a Cochrane review and one RCT found that Vitamin A did not improve clinical outcomes. For Vitamin D, an RCT evaluating a single high dose of 100 000 international units (IU) of vitamin D found a reduction in time to improvement, with 38%-40% documented vitamin D deficiency at baseline. However, two other studies of 1000 IU daily did not show any effect, but vitamin D status was not measured. For vitamin C, two studies found a reduction in time to symptom resolution in those with severe disease, with one reporting a shorter length of hospital stay. However, both studies were of weak quality. Most studies excluded malnourished children, and studies which included these children did not report specifically on the effect of micronutrients. Conclusions This review found that adjunctive zinc and vitamin A, in addition to standard care, does not improve clinical outcomes in children with severe pneumonia in LMICs (strong evidence). However, a reduction in time to symptom resolution was reported with high dose vitamin D supplementation in children with documented vitamin D deficiency (strong evidence from one study) and vitamin C (weak evidence), although further research is needed, especially in underweight children.
Collapse
Affiliation(s)
- Maeve Hume-Nixon
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Hamish Graham
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Royal Children's Hospital Melbourne, Flemington Road, Parkville, Victoria, Australia
| | - Fiona Russell
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kim Mulholland
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amanda Gwee
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Royal Children's Hospital Melbourne, Flemington Road, Parkville, Victoria, Australia
| | | |
Collapse
|
5
|
Khoshnevisasl P, Sadeghzadeh M, Kamali K, Ardalani A. A randomized clinical trial to assess the effect of zinc and vitamin D supplementation in addition to hypertonic saline on treatment of acute bronchiolitis. BMC Infect Dis 2022; 22:538. [PMID: 35692038 PMCID: PMC9190165 DOI: 10.1186/s12879-022-07492-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Bronchiolitis, the most common cause of hospitalization in infancy has not yet a definitive treatment. This study was conducted to assess the effect of Zinc and vitamin D on treatment of infants with bronchiolitis. Methods In this double blind, randomized clinical trial, 94 infants aged 2 to 23 months, admitted in Mousavi Hospital in Zanjan, Iran, with the diagnosis of acute bronchiolitis were randomly assigned into 3 groups. The control group was only treated with hypertonic saline. The two case groups received either 100 unit/kg/day of Vitamin D or 20 mg/day of zinc in addition to hypertonic saline. Wheezing, duration of hospital stay, cough, cyanosis, respiratory distress and the respiratory rate in the first, third and seventh day of hospitalization were evaluated. Results There was no significant difference between groups in terms of age, sex, weight, passive smoking, wheezing, oxygen saturation, cyanosis and type of delivery. On the third day of hospitalization, the respiratory rate/min in the control group, the groups receiving vitamin D and zinc were 45.2 ± 10.7, 37.8 ± 3.9 and 41.1 ± 9.1 respectively and the result of repeated measure analysis didn’t show any significant difference between the 3 groups (P = 0.562). Duration of hospitalization in the group receiving Vitamin D or zinc and in controls were 4.2 ± 2.6, 4.4 ± 2.2 and 5.1 ± 2.4 days respectively and this difference was not significant. Zinc receiving patients did not differ from the control group regarding to respiratory rate, cyanosis and wheezing. Conclusion Vitamin D or zinc administration was not effective in reducing respiratory rate in children with bronchiolitis. Trial registration This project was approved by the Institutional Ethics Committee (IR, ZUMS.REC.1396.50), and registered on IRCT (IRCT20131217015835N7).
Collapse
Affiliation(s)
- Parisa Khoshnevisasl
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mansour Sadeghzadeh
- Metabolic Disease Research Center, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Koorosh Kamali
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Armita Ardalani
- Department of Pediatrics, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
6
|
Krone A, Fu Y, Schreiber S, Kotrba J, Borde L, Nötzold A, Thurm C, Negele J, Franz T, Stegemann-Koniszewski S, Schreiber J, Garbers C, Shukla A, Geffers R, Schraven B, Reinhold D, Dudeck A, Reinhold A, Müller AJ, Kahlfuss S. Ionic mitigation of CD4 + T cell metabolic fitness, Th1 central nervous system autoimmunity and Th2 asthmatic airway inflammation by therapeutic zinc. Sci Rep 2022; 12:1943. [PMID: 35121767 PMCID: PMC8816938 DOI: 10.1038/s41598-022-04827-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/24/2021] [Indexed: 12/18/2022] Open
Abstract
T helper (Th) cells provide immunity to pathogens but also contribute to detrimental immune responses during allergy and autoimmunity. Th2 cells mediate asthmatic airway inflammation and Th1 cells are involved in the pathogenesis of multiple sclerosis. T cell activation involves complex transcriptional networks and metabolic reprogramming, which enable proliferation and differentiation into Th1 and Th2 cells. The essential trace element zinc has reported immunomodulatory capacity and high zinc concentrations interfere with T cell function. However, how high doses of zinc affect T cell gene networks and metabolism remained so far elusive. Herein, we demonstrate by means of transcriptomic analysis that zinc aspartate (UNIZINK), a registered pharmaceutical infusion solution with high bioavailability, negatively regulates gene networks controlling DNA replication and the energy metabolism of murine CD3/CD28-activated CD4+ T cells. Specifically, in the presence of zinc, CD4+ T cells show impaired expression of cell cycle, glycolytic and tricarboxylic acid cycle genes, which functionally cumulates in reduced glycolysis, oxidative phosphorylation, metabolic fitness and viability. Moreover, high zinc concentrations impaired nuclear expression of the metabolic transcription factor MYC, prevented Th1 and Th2 differentiation in vitro and reduced Th1 autoimmune central nervous system (CNS) inflammation and Th2 asthmatic airway inflammation induced by house dust mites in vivo. Together, we find that higher zinc doses impair the metabolic fitness of CD4+ T cells and prevent Th1 CNS autoimmunity and Th2 allergy.
Collapse
MESH Headings
- Animals
- Aspartic Acid/analogs & derivatives
- Aspartic Acid/pharmacology
- Asthma/drug therapy
- Asthma/genetics
- Asthma/immunology
- Asthma/metabolism
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/metabolism
- Cell Proliferation/drug effects
- Cells, Cultured
- Central Nervous System/drug effects
- Central Nervous System/immunology
- Central Nervous System/metabolism
- Encephalomyelitis, Autoimmune, Experimental/drug therapy
- Encephalomyelitis, Autoimmune, Experimental/genetics
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Encephalomyelitis, Autoimmune, Experimental/metabolism
- Energy Metabolism/drug effects
- Energy Metabolism/genetics
- Gene Expression Regulation
- Immunomodulating Agents/pharmacology
- Lung/drug effects
- Lung/immunology
- Lung/metabolism
- Lymphocyte Activation/drug effects
- Lymphocyte Activation/genetics
- Mice, Inbred C57BL
- Mice, Transgenic
- Pneumonia/drug therapy
- Pneumonia/genetics
- Pneumonia/immunology
- Pneumonia/metabolism
- Pyroglyphidae/immunology
- Signal Transduction
- Th1 Cells/drug effects
- Th1 Cells/immunology
- Th1 Cells/metabolism
- Th2 Cells/drug effects
- Th2 Cells/immunology
- Th2 Cells/metabolism
- Transcription, Genetic
- Zinc Compounds/pharmacology
- Mice
Collapse
Affiliation(s)
- Anna Krone
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Yan Fu
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Simon Schreiber
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Johanna Kotrba
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Loisa Borde
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Aileen Nötzold
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christoph Thurm
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany
| | - Jonas Negele
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Tobias Franz
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sabine Stegemann-Koniszewski
- Experimental Pneumology, Department of Pneumology, University Hospital Magdeburg/Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GCI3), Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany
| | - Jens Schreiber
- Experimental Pneumology, Department of Pneumology, University Hospital Magdeburg/Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GCI3), Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany
| | - Christoph Garbers
- Institute of Pathology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GCI3), Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany
| | - Aniruddh Shukla
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Geffers
- Genome Analytics, Helmholtz-Center for Infection Research (HZI), Braunschweig, Germany
| | - Burkhart Schraven
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GCI3), Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany
| | - Dirk Reinhold
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GCI3), Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany
| | - Anne Dudeck
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GCI3), Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany
| | - Annegret Reinhold
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GCI3), Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany
| | - Andreas J Müller
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- Intravital Microscopy of Infection and Immunity, Helmholtz-Center for Infection Research (HZI), Braunschweig, Germany
- Health Campus Immunology, Infectiology and Inflammation (GCI3), Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany
| | - Sascha Kahlfuss
- Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- Health Campus Immunology, Infectiology and Inflammation (GCI3), Medical Faculty, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany.
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke-University, Magdeburg, Germany.
| |
Collapse
|
7
|
Sobczyk MK, Gaunt TR. The Effect of Circulating Zinc, Selenium, Copper and Vitamin K 1 on COVID-19 Outcomes: A Mendelian Randomization Study. Nutrients 2022; 14:233. [PMID: 35057415 PMCID: PMC8780111 DOI: 10.3390/nu14020233] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/22/2022] Open
Abstract
Background & Aims: Previous results from observational, interventional studies and in vitro experiments suggest that certain micronutrients possess anti-viral and immunomodulatory activities. In particular, it has been hypothesized that zinc, selenium, copper and vitamin K1 have strong potential for prophylaxis and treatment of COVID-19. We aimed to test whether genetically predicted Zn, Se, Cu or vitamin K1 levels have a causal effect on COVID-19 related outcomes, including risk of infection, hospitalization and critical illness. Methods: We employed a two-sample Mendelian Randomization (MR) analysis. Our genetic variants derived from European-ancestry GWAS reflected circulating levels of Zn, Cu, Se in red blood cells as well as Se and vitamin K1 in serum/plasma. For the COVID-19 outcome GWAS, we used infection, hospitalization or critical illness. Our inverse-variance weighted (IVW) MR analysis was complemented by sensitivity analyses including a more liberal selection of variants at a genome-wide sub-significant threshold, MR-Egger and weighted median/mode tests. Results: Circulating micronutrient levels show limited evidence of association with COVID-19 infection, with the odds ratio [OR] ranging from 0.97 (95% CI: 0.87-1.08, p-value = 0.55) for zinc to 1.07 (95% CI: 1.00-1.14, p-value = 0.06)-i.e., no beneficial effect for copper was observed per 1 SD increase in exposure. Similarly minimal evidence was obtained for the hospitalization and critical illness outcomes with OR from 0.98 (95% CI: 0.87-1.09, p-value = 0.66) for vitamin K1 to 1.07 (95% CI: 0.88-1.29, p-value = 0.49) for copper, and from 0.93 (95% CI: 0.72-1.19, p-value = 0.55) for vitamin K1 to 1.21 (95% CI: 0.79-1.86, p-value = 0.39) for zinc, respectively. Conclusions: This study does not provide evidence that supplementation with zinc, selenium, copper or vitamin K1 can prevent SARS-CoV-2 infection, critical illness or hospitalization for COVID-19.
Collapse
Affiliation(s)
- Maria K. Sobczyk
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK;
| | | |
Collapse
|
8
|
Arolkar P, Damle G, Gala P. Role of nutrition in pediatric patients with respiratory failure. INDIAN JOURNAL OF RESPIRATORY CARE 2022. [DOI: 10.4103/ijrc.ijrc_162_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
9
|
Santos HO. Therapeutic supplementation with zinc in the management of COVID-19-related diarrhea and ageusia/dysgeusia: mechanisms and clues for a personalized dosage regimen. Nutr Rev 2021; 80:1086-1093. [PMID: 34338769 PMCID: PMC8385805 DOI: 10.1093/nutrit/nuab054] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Zinc supplementation is indicated for diarrhea and taste disorders, which are both features of COVID-19. Nevertheless, this strategy has not been tested for the treatment of these secondary complications in the current pandemic. Through an updated review, a practical appraisal was considered as a means of providing a medical nexus of therapeutic zinc regimens as an adjunct in the management of COVID-19–related diarrhea and ageusia/dysgeusia. While diarrhea and taste disorders are consequences of COVID-19, zinc supplementation is useful for non–COVID-19 patients with these clinical problems. The overwhelming evidence for supplementing with zinc in diarrhea and pneumonia is associated with the treatment of children, while for taste disorders the use of supplementing with zinc is more examined in adults. Whereas COVID-19 is more prevalent in adults, precautions should be exercised not to translate the zinc dosage used for children with diarrhea and taste disorders into the current pandemic. Therapeutic doses of zinc used for adults (∼50–150 mg/day of elemental zinc) could be included in the treatment strategies for COVID-19, but this proposal should be examined through randomized studies.
Collapse
Affiliation(s)
- Heitor O Santos
- H.O. Santos is with the School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil
- H.O. Santos, School of Medicine, Federal University of Uberlandia (UFU), Para Street, 1720, Umuarama, Block 2H, Uberlandia, 38400-902 MG, Brazil. E-mail:
| |
Collapse
|
10
|
Chinni V, El-Khoury J, Perera M, Bellomo R, Jones D, Bolton D, Ischia J, Patel O. Zinc supplementation as an adjunct therapy for COVID-19: Challenges and opportunities. Br J Clin Pharmacol 2021; 87:3737-3746. [PMID: 33742473 PMCID: PMC8250380 DOI: 10.1111/bcp.14826] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/11/2021] [Accepted: 02/27/2021] [Indexed: 01/19/2023] Open
Abstract
An outbreak of a novel coronavirus (COVID‐19 or 2019‐CoV) infection has posed significant threats to international health and the economy. Patients with COVID‐19 are at risk of cytokine storm, acute respiratory distress syndrome (ARDS), reduced blood oxygenation, mechanical ventilation, and a high death rate. Although recent studies have shown remdesivir and dexamethasone as treatment options, there is an urgent need to find a treatment to inhibit virus replication and to control the progression of the disease. Essential biometal zinc has generated a lot of excitement as one of the promising candidates to reduce the severity of COVID‐19 infection. Several published observations outlined in the review are the reasons why there is a global enthusiasm that zinc therapy could be a possible therapeutic option. However, the biggest challenge in realising the therapeutic value of zinc is lack of optimal treatment modalities such as dose, duration of zinc supplementation and the mode of delivery. In this review, we discuss the regulatory mechanism that hinges upon the bioavailability of zinc. Finally, we propose that intravenous zinc could circumvent the confounding factors affecting the bioavailability of zinc and allow zinc to achieve its therapeutic potential. If successful, due to advantages such as lack of toxicity, low cost and ease of availability, intravenous zinc could be rapidly implemented clinically.
Collapse
Affiliation(s)
- Vidyasagar Chinni
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - John El-Khoury
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, The University of Melbourne, Parkville, Victoria, Australia.,Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - Daryl Jones
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Joseph Ischia
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Oneel Patel
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
11
|
Saka Y, Naruse T, Matsumoto J, Takeda Y, Onogi C, Yokoi J, Kato A, Tawada N, Noda Y, Niwa S, Mimura T, Watanabe Y. Low Serum Zinc Concentration Is Associated With Infection Particularly in Patients With Stage 5 Chronic Kidney Disease Medicated with Proton Pump Inhibitors. J Ren Nutr 2021; 31:579-585. [PMID: 33642192 DOI: 10.1053/j.jrn.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 10/15/2020] [Accepted: 11/01/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Zinc (Zn) plays an important role in immune function. Several studies have identified an association between a Zn deficiency and infection. Infectious diseases are major complications of chronic kidney disease (CKD). We investigated whether serum Zn concentrations are associated with risk of infection in patients with advanced CKD. DESIGN AND METHODS We retrospectively analyzed data from 299 patients with CKD whose serum Zn values were measured to evaluate anemia between January 2013 and December 2016. Among them, 9 who were supplemented with Zn and 67 who had started urgent dialysis at the time of measurement were excluded. We analyzed infection events, length of infection-related hospitalization and infection-related and all-cause mortality in the remaining 223 patients during a median follow-up of 36 months. We assigned the patients to groups with low or high Zn values (≤50 and >50 μg/dL, respectively) based on a median value of 50 μg/dL. Data were analyzed using Kaplan-Meier curves and Cox hazards models. RESULTS During a median follow-up of 36 months, 40 patients were hospitalized with infections. The rate of infection-related and long-term hospitalization (>10 days) due to infection was higher for patients with low, than high, Zn values (23.3% vs. 12.6%; P = .042 and 26.2% vs. 12.4%; P = .007, respectively). After adjustment in Cox hazards models, low serum Zn values remained an independent risk factor for infection-related hospitalization (Hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.01-3.71; P = .048), especially for patients on proton pump inhibitor (PPI) medications (HR, 2.66, 95%; CI, 1.22-5.81; P = .014). CONCLUSION Patients with advanced CKD accompanied by low serum Zn concentration, and particularly those medicated with PPI, are at high risk of infection-related hospitalization, which results in long-term hospitalization.
Collapse
Affiliation(s)
- Yosuke Saka
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan.
| | - Tomohiko Naruse
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Jun Matsumoto
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Yuka Takeda
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Chikao Onogi
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Junpei Yokoi
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Akihisa Kato
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Naoto Tawada
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Yuhei Noda
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Syunsuke Niwa
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Tetsushi Mimura
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Yuzo Watanabe
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| |
Collapse
|
12
|
Abstract
A wide variety of symptoms is associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, and these symptoms can overlap with other conditions and diseases. Knowing the distribution of symptoms across diseases and individuals can support clinical actions on timelines shorter than those for drug and vaccine development. Here, we focus on zinc deficiency symptoms, symptom overlap with other conditions, as well as zinc effects on immune health and mechanistic zinc deficiency risk groups. There are well-studied beneficial effects of zinc on the immune system including a decreased susceptibility to and improved clinical outcomes for infectious pathogens including multiple viruses. Zinc is also an anti-inflammatory and anti-oxidative stress agent, relevant to some severe Coronavirus Disease 2019 (COVID-19) symptoms. Unfortunately, zinc deficiency is common worldwide and not exclusive to the developing world. Lifestyle choices and preexisting conditions alone can result in zinc deficiency, and we compile zinc risk groups based on a review of the literature. It is also important to distinguish chronic zinc deficiency from deficiency acquired upon viral infection and immune response and their different supplementation strategies. Zinc is being considered as prophylactic or adjunct therapy for COVID-19, with 12 clinical trials underway, highlighting the relevance of this trace element for global pandemics. Using the example of zinc, we show that there is a critical need for a deeper understanding of essential trace elements in human health, and the resulting deficiency symptoms and their overlap with other conditions. This knowledge will directly support human immune health for decreasing susceptibility, shortening illness duration, and preventing progression to severe cases in the current and future pandemics.
Collapse
Affiliation(s)
- Marcin P. Joachimiak
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, United States of America
| |
Collapse
|
13
|
Kennedy CU, Chukwuebuka NO, Uchenna E. Serum Zinc Levels in Apparently Healthy Children in Nigeria: Are They Acceptable. Niger Med J 2020; 61:291-296. [PMID: 33888923 PMCID: PMC8040947 DOI: 10.4103/nmj.nmj_20_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Despite the importance of zinc in the human body, there is paucity of data on the zinc status of Nigerian children. The aim of this study was to determine the serum zinc levels of children attending the pediatric outpatient clinic of a tertiary hospital in South East Nigeria and to assess their need for routine zinc supplementation. Materials and Methods: One hundred children aged 5–60 months were recruited consecutively from the pediatric outpatient clinic. Their socioeconomic class (SEC) was assessed using the tool developed by Oyedeji. Physical examination was carried out to exclude malnutrition and/or liver disease. Samples were collected in the morning from nonfasting subjects and were analyzed using atomic absorption spectrophotometer. Serum zinc deficiency was defined as zinc level <80 μg/dl. Results: The overall median (range) serum zinc level was 83.3ug/dl (60–105 μg/dl) while the median (mean rank) serum zinc levels among male and female subjects were 83.4 μg/dl and 84.2ug/dl, respectively (U = 1071.00; P = 0.228). A total of 26 (26%) apparently healthy children had low serum zinc levels. There was no association between gender and serum zinc levels (χ2 = 2.163; P = 0.141). A significant positive but weak relationship was found between SEC and zinc levels (r = 0.208, P = 0.038) but not between serum zinc levels and age of the children (r = 0.185, P = 0.065). Conclusion: A significant proportion of Under-5s could have low serum zinc levels. Routine zinc supplementation may be necessary among this age group in Nigeria.
Collapse
Affiliation(s)
| | | | - Ekwochi Uchenna
- Department of Pediatrics, Enugu State University College of Medicine, Enugu, Nigeria
| |
Collapse
|
14
|
Kesavelu D, Franklyn N, Sreedharan L. Can Nutrition Play a Role as a Stimulant for COVID 19 in Children? Rev Recent Clin Trials 2020; 16:146-150. [PMID: 33148157 DOI: 10.2174/1574887115666201104154713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Nutrition plays a major role in the growth and well-being of children and forms the basis of their existence. A pandemic like COVID19 poses some serious questions and challenges in the minds of practicing pediatricians as to what support they should offer children, their parents and carers alleviating their anxiety about their children's diet and nutrition, that is critical at this time of crisis. Although the evidence for pediatric nutrition and COVID19 is not strong, this article aims to critically look into pediatric nutrition during the COVID19 pandemic and bring the most recent evidence into the limelight to facilitate making the right choices with respect to pediatric nutrition. METHODS We performed a search on recent literature using the search terms "Covid19" + "Children" + "Nutrition" to analyze the current evidence supporting nutrition as a stimulant for covid19. A review article based on the above search results was written to highlight the importance of nutrition during this pandemic. RESULTS Strong recommendations remain unchanged for breastfeeding, healthy complementary feeding, use of supplemental formula where appropriate, oral nutritional supplements, zinc, n-3& n- 6 fatty acids, and probiotics all have a certain role to play as a stimulant for Covid19 in children. CONCLUSION Current evidence emphasizes the use of additional nutritional supplements, especially in the "at risk" groups, low socio-economic status and children with chronic medical problems. Paediatric nutrition should never be overlooked and "one size does not fit all" as every child is different and children's individual nutritional needs vary. This review points to the importance of nutrition as a stimulant to covid19 in the pediatric population.
Collapse
Affiliation(s)
| | | | - Lekha Sreedharan
- Department of Dietetics and Nutrition, Apollo Children's Hospital, Chennai, India
| |
Collapse
|
15
|
Brown N, Kukka AJ, Mårtensson A. Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Paediatr Open 2020; 4:e000662. [PMID: 32685705 PMCID: PMC7359381 DOI: 10.1136/bmjpo-2020-000662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active. METHODS Systematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed. RESULTS We identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions. CONCLUSION There is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs. TRIAL REGISTRATION NUMBER CRD42019141602.
Collapse
Affiliation(s)
- Nick Brown
- IMCH, Kvinno och barnhälsa, Uppsala Universitet, Uppsala, Sweden
| | | | | |
Collapse
|
16
|
Yorulmaz H, Ozkok E, Demir G, Ertugrul Yalcin I, Ates G, Olgac V, Tamer S. Pretreatment of simvastatin on liver trace element levels during endotoxemia. Arch Physiol Biochem 2020; 126:196-200. [PMID: 30450988 DOI: 10.1080/13813455.2018.1508234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There are a number of studies investigating anti-inflammatory effects of simvastatin in patients with sepsis and animal models. There are a few studies which investigated effect of simvastatin on elements in sepsis. In the present study, the impact of pretreatment with simvastatin on element levels was evaluated in liver during endotoxemia. Rats were divided into control, LPS, simvastatin, and simvastatin + LPS. The histopathologic examination of the liver was performed using hematoxylin and eosin. Selenium, zinc, iron, manganese, magnesium, and copper were analyzed using inductively coupled plasma - optical emission spectroscopy. In the LPS, the hepatocyte cell structure was damaged. In the simvastatin + LPS, hepatocyte, and sinusoidal cord damage were partially smaller than LPS. Levels of selenium, and copper significantly decreased in both of LPS and simvastatin + LPS. In the LPS group, iron was found to increase. In the simvastatin + LPS, zinc was increased. Simvastatin partially smaller liver damage by increasing zinc levels during endotoxemia.
Collapse
Affiliation(s)
| | - Elif Ozkok
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Goksel Demir
- Department of Urban, and Regional Planning, Faculty of Architecture, Kirklareli University, Kirklareli, Turkey
| | - Ibrahim Ertugrul Yalcin
- Department of Molecular Biology, and Genetics, Faculty of Engineering and Natural Sciences, Bahcesehir University, Istanbul, Turkey
| | - Gulten Ates
- Department of Physiology, Faculty of Medicine, Istanbul Yeni Yuzyil University, Istanbul, Turkey
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Vakur Olgac
- Department of Pathology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Sule Tamer
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
17
|
Sabin LL, Estrella B, Sempértegui F, Farquhar N, Mesic A, Halim N, Lin CY, Rodriguez O, Hamer DH. Household Costs Associated with Hospitalization of Children with Severe Pneumonia in Quito, Ecuador. Am J Trop Med Hyg 2020; 102:731-739. [PMID: 32067631 DOI: 10.4269/ajtmh.19-0721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pneumonia remains a leading cause of morbidity and mortality in young children. The total cost of pneumonia-related hospitalization, including household-level cost, is poorly understood. To better understand this burden in an urban setting in South America, we incorporated a cost study into a trial assessing zinc supplements in treatment of severe pneumonia among children aged 2-59 months at a public hospital in Quito, Ecuador, which provides such treatment at no charge. Data were collected from children's caregivers at hospitalization and discharge on out-of-pocket payments for medical and nonmedical items, and on employment and lost work time. Analyses encompassed three categories: direct medical costs, direct nonmedical costs, and indirect costs, which covered foregone wages (from caregivers' self-reported lost earnings) and opportunity cost of caregivers' lost time (based on the unskilled labor wage in Ecuador). Caregivers of 153 children completed all questionnaires. Overall, 57% of children were aged less than 12 months, and 46% were female. Just over 50% of mothers and fathers had completed middle school. Most reported direct costs, which averaged $33. Most also reported indirect costs, the mean of which was $74. Fifty-seven reported lost earnings (mean = $79); 29 reported lost time (estimated mean cost = $37). Stratified analyses revealed similar costs for children < 12 months and ≥ 12 months, with variations for specific items. Costs for hospital-based treatment of severe pneumonia in young children represent a major burden for households in low- to middle-income settings, even when such treatment is intended to be provided at no cost.
Collapse
Affiliation(s)
- Lora L Sabin
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Bertha Estrella
- Escuela de Medicina, Universidad Central del Ecuador, Quito, Ecuador.,Corporacion Ecuatoriana de Biotecnologia, Quito, Ecuador
| | - Fernando Sempértegui
- Escuela de Medicina, Universidad Central del Ecuador, Quito, Ecuador.,Corporacion Ecuatoriana de Biotecnologia, Quito, Ecuador
| | - Norman Farquhar
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan
| | - Aldina Mesic
- Innovations for Poverty Action Zambia, Lusaka, Zambia
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Chia-Ying Lin
- United States Agency for International Development, Arlington, Virginia
| | | | - Davidson H Hamer
- Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| |
Collapse
|
18
|
Serum Zinc Levels in Children 1 - 59 Months of Age with Pneumonia: A Single-Center Surveillance in India from 2014 to 2016. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2020. [DOI: 10.5812/pedinfect.98735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Hamed AMM, Kassem YT, Fayed HK, Solaiman AM. Serum zinc levels in hospitalized children with pneumonia: a hospital-based case–control study. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_30_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
20
|
Rerksuppaphol S, Rerksuppaphol L. A randomized controlled trial of zinc supplementation in the treatment of acute respiratory tract infection in Thai children. Pediatr Rep 2019; 11:7954. [PMID: 31214301 PMCID: PMC6548996 DOI: 10.4081/pr.2019.7954] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/08/2019] [Indexed: 01/27/2023] Open
Abstract
Acute Lower Respiratory Tract Infections (ALRI) are one of the most common causes of morbidity and mortality in young children. Zinc supplementation has been shown to have a preventive effect against respiratory infections, but little evidence is available on its effect on the treatment of ALRI. This study examined the effect of zinc supplementation on the treatment outcome in children that were hospitalized with ALRI. A randomized, doubleblinded, placebo-controlled trial was conducted on 64 hospitalized children with ALRI, who were aged between 2 and 60 months. Children were randomly allocated to receive zinc (30 mg elemental zinc/day) or placebo. The primary outcome was the time to the cessation of ALRI, while the secondary outcomes were the length of the stay in hospital and the individual features of the disease. The study found that ALRI cessation was faster in children who received zinc supplementation (median (IQR): 3 (2-4) days and 4 (3-5) days, respectively; P=0.008), and that their hospital stay was shorter (mean (SD): 3.8 (1.3) days and 6.1 (3.2) days, respectively; P<0.001) than the placebo group. Zinc supplementation was well-tolerated, and no adverse events were reported. In conclusion, zinc supplementation reduced the number of days of ALRI in Thai children, as well as their stay in hospital.
Collapse
Affiliation(s)
| | - Lakkana Rerksuppaphol
- Department of Preventive Medicine, Faculty of Medicine, Srinakharinwirot University, Thailand
| |
Collapse
|
21
|
Laghari GS, Hussain Z, Taimur M, Jamil N. Therapeutic Role of Zinc Supplementation in Children Hospitalized with Pneumonia. Cureus 2019; 11:e4475. [PMID: 31249752 PMCID: PMC6579359 DOI: 10.7759/cureus.4475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction Pneumonia is one of the major causes of death in children younger than age five, especially in developing countries. The World Health Organization recommends children from a developing country take zinc supplements. We conducted this study to explore the efficacy of zinc supplementation in alleviating symptoms and shortening of hospital stay in children with pneumonia. Materials and methods We conducted this prospective, randomized controlled trial in the Department of Pediatrics, Civil Hospital, Jamshoro. We included 100 children of both genders randomized into two equal groups of zinc-supplemented and non-zinc-supplemented study groups after informed consent was obtained from the parents and legal guardians. The participants were aged 28 days to five years and admitted in the hospital with pneumonia. We monitored for hypoxia, tachypnea, chest indrawing, and cyanosis, and we recorded the total length of hospital stay for each group. Results We found no significant difference in symptom changes (i.e., hypoxia, tachypnea, chest indrawing, and cyanosis) between the zinc and non-zinc groups. However, hospital length of stay was significantly shorter for patients in the zinc-supplemented group compared to the non-zinc-supplemented group. Conclusion Zinc supplementation did not yield a statistically significant reduction in symptoms in children with severe pneumonia. Zinc supplements given during an acute episode are not beneficial in short-term clinical recovery from severe pneumonia in hospitalized children.
Collapse
Affiliation(s)
| | - Zahid Hussain
- Pediatrics, National Institute of Child Health, Karachi, PAK
| | - Muhammad Taimur
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Nasir Jamil
- Miscellaneous, University of Karachi, Karachi, PAK
| |
Collapse
|
22
|
Escobedo Monge MF, Barrado E, Alonso Vicente C, Redondo Del Río MP, Marugán de Miguelsanz JM. Zinc Nutritional Status in Patients with Cystic Fibrosis. Nutrients 2019; 11:E150. [PMID: 30642010 PMCID: PMC6356838 DOI: 10.3390/nu11010150] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Zinc is an essential nutrient for all forms of life and its deficiency affects the normal growth and development of human beings. OBJECTIVE The main aim was to investigate zinc nutritional status by serum zinc concentration (SZC) and dietary zinc intake and their association in cystic fibrosis (CF) patients. METHODS A cross-sectional study was conducted in CF patients. Anthropometric measurements and respiratory and pancreatic tests were conducted. Hypozincemia was determined by SZC while using atomic absorption spectrophotometry and dietary zinc deficiency by prospective 72-h dietary surveys. RESULTS Mean SZC (87.2 ± 16.7 μg/dL) and dietary zinc intake (97 ± 26.9% Dietary Reference Intake) were normal. Three of 17 patients with CF (17.6%) had hypozincemia and four (23.5%) had a dietary zinc deficiency. No patient with dietary zinc deficiency had hypozincemia. A positive and significant association was observed between SZC and Z-score of BMI-for-age (p = 0.048) and weight-for-height (p = 0.012) and between dietary zinc intake and energy intake (EI, p = 0.036) and Z-score of weight-for-high (p = 0.029). CONCLUSION SZC was associated with the nutritional status, expressed as BMI (Body Mass Index) and weight-for-height Z score, and dietary zinc intake with EI and weight-for-height Z-score. No patient with hypozincemia had dietary zinc deficiency. This situation should alert us to a marginal zinc deficiency and it may explain why there were no overlapping cases between the two groups. We suggest that probably 41% of the cases in this study would be at elevated risk of zinc deficiency and a zinc supplementation may be considered.
Collapse
Affiliation(s)
| | - Enrique Barrado
- Department of Analytical Chemistry, Science Faculty, University of Valladolid, Campus Miguel Delibes, Calle Paseo de Belén, 7, 47011 Valladolid, Spain.
| | - Carmen Alonso Vicente
- Department of Paediatrics of the Faculty of Medicine, Valladolid University; Section of Gastroenterology and Pediatric Nutrition, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 7, 47005Valladolid, Spain.
| | | | - José Manuel Marugán de Miguelsanz
- Department of Paediatrics of the Faculty of Medicine, Valladolid University; Section of Gastroenterology and Pediatric Nutrition, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 7, 47005Valladolid, Spain.
| |
Collapse
|
23
|
Xie J, Zhu L, Zhu T, Jian Y, Ding Y, Zhou M, Feng X. Zinc supplementation reduces Candida infections in pediatric intensive care unit: a randomized placebo-controlled clinical trial. J Clin Biochem Nutr 2018; 64:170-173. [PMID: 30936630 PMCID: PMC6436042 DOI: 10.3164/jcbn.18-74] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022] Open
Abstract
Resistance to anti-fungal drugs has become the main cause for increasing incidence rate of Candida infections in pediatric intensive care units (PICU). Zinc supplementation has been shown to exhibit beneficial effects on many pediatric illnesses. This study aimed to investigate the efficacy of zinc supplementation on prevalence of candidemia and candiduria infections in PICU. 724 eligible children between 1 to 5 years old admitted in PICU were randomly assigned into either zinc supplementation group or placebo group. Primary endpoints were the number of Candida infections, length of PICU stay and cases of patient death 14 days after enrollment. Secondary endpoints were the incidence rates of candidemia and candiduria. The incidences of candiduria and candidemia were significantly lower in the zinc group than the placebo group. The length of PICU stay and cases of patient death were obviously lowered in the zinc group compared to the placebo group. In conclusion, zinc supplementation shows beneficial clinical efficacy in reducing Candida infections among PICU patients on broad-spectrum antibiotics with critical illnesses.
Collapse
Affiliation(s)
- Jun Xie
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Lihong Zhu
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Tingli Zhu
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Ying Jian
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Ye Ding
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Min Zhou
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Xiaoyan Feng
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| |
Collapse
|
24
|
Bom APDA, Corrêa IBS, Argondizzo APC, Medeiros MA, Santos RBD, Souza TLFD, Silva Junior JGD. Conformational analysis of Pneumococcal Surface Antigen A (PsaA) upon zinc binding by fluorescence spectroscopy. AN ACAD BRAS CIENC 2018; 90:2299-2310. [PMID: 29947666 DOI: 10.1590/0001-3765201820170151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/28/2017] [Indexed: 11/22/2022] Open
Abstract
PsaA (pneumococcal surface antigen A) is a S. pneumoniae virulence factor that belongs to the metal transport system. The Manganese PsaA binding has been associated with oxidative stress resistance becoming a pivotal element in the bacteria virulence. It has been shown that Zinc inhibits the Manganese acquisition and promotes bacteria toxicity. We have performed a PsaA conformational analysis both in the presence (Zn-rPsaA) and in the absence of Zinc (free-rPsaA). We performed experiments in the presence of different Zinc concentrations to determine the metal minimum concentration which induced a conformational change. The protein in free and Zn-binding condition was also studied in pH ranging 2.6-8.0 and in temperature ranging 25oC-85oC. pH experiments showed a decrease of fluorescence intensity only in acidic medium. Analysis of the heat-induced denaturation demonstrated that Zinc-binding promoted an increase in melting temperature from 55oC (free-rPsaA) to 78.8oC (Zn-rPsaA) according to fluorescence measurements. In addition, the rPsaA stabilization by Zinc was verified through analysis of urea and guanidine hydrochloride denaturation. Data showed that Zinc promoted an increase in the rPsaA stability and its removal by EDTA can lead to a PsaA intermediate conformation. These findings can be considered in the development of vaccines containing PsaA as antigen.
Collapse
Affiliation(s)
- Ana Paula D Ano Bom
- Lab. of Macromolecules, Bio-Manguinhos, Fiocruz, Av. Brasil, 4365, Room 205, Manguinhos, 21040-900 Rio de Janeiro, RJ, Brazil
| | - Izabella B S Corrêa
- Lab. of Macromolecules, Bio-Manguinhos, Fiocruz, Av. Brasil, 4365, Room 205, Manguinhos, 21040-900 Rio de Janeiro, RJ, Brazil
| | - Ana Paula C Argondizzo
- Lab. of Recombinant Technologies, Bio-Manguinhos, Fiocruz, Av. Brasil, 4365, Room 209, Manguinhos, 21040-900 Rio de Janeiro, RJ, Brazil
| | - Marco Alberto Medeiros
- Lab. of Recombinant Technologies, Bio-Manguinhos, Fiocruz, Av. Brasil, 4365, Room 209, Manguinhos, 21040-900 Rio de Janeiro, RJ, Brazil
| | - Roger B Dos Santos
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Av Carlos Chagas Filho, 373, Room 21, Ilha do Fundão, 21941-901 Rio de Janeiro, RJ, Brazil
| | - Theo Luiz F de Souza
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Av Carlos Chagas Filho, 373, Room 21, Ilha do Fundão, 21941-901 Rio de Janeiro, RJ, Brazil
| | - José G da Silva Junior
- Lab. of Macromolecules, Bio-Manguinhos, Fiocruz, Av. Brasil, 4365, Room 205, Manguinhos, 21040-900 Rio de Janeiro, RJ, Brazil
| |
Collapse
|
25
|
Saleh NY, Abo El Fotoh WMM. Low serum zinc level: The relationship with severe pneumonia and survival in critically ill children. Int J Clin Pract 2018; 72:e13211. [PMID: 29855123 DOI: 10.1111/ijcp.13211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/30/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Zinc deficiency is common among children in developing countries; but, there is still conflicting evidence on whether the alteration in zinc metabolism is the predictive of disease severity in the setting of critical illness. OBJECTIVES To assess serum zinc levels in children admitted with pneumonia, and also to study the relationship between zinc levels and severity and mortality from pneumonia. METHODS In a prospective cohort study, we enrolled 320 critically ill children admitted to the paediatric intensive care unit (PICU) with severe pneumonia (group 1) in addition to 160 children admitted into wards with pneumonia (group 2). Serum zinc measured in all patients on admission. RESULTS Serum zinc level was significantly lower among patients admitted to PICU (group 1) compared with patients admitted to wards (group 2) (P < .001). There was a highly statistically significant decrease in zinc level in critically ill children complicated by sepsis, mechanically ventilated cases and those who died. Regarding the diagnosis of sepsis, zinc had an area under the curve (AUC) of 0.81 while C-reactive protein (CRP) had an AUC of 0.83. Regarding the prognosis, zinc had an AUC of 0.649 for prediction of mortality, whereas the AUC for Pediatric risk of mortality (PRISM), Pediatric index of mortality2 (PIM2) and CRP were 0.83, 0.82 and 0.78, respectively. The combined zinc with PRISM and PIM2 has increased the sensitivity of zinc for mortality from 86.5% to 94.9%. CONCLUSION Zinc has both a diagnostic and a prognostic value for children with pneumonia.
Collapse
Affiliation(s)
- Nagwan Yossery Saleh
- Department of Pediatrics, Faculty of Medicine, Menoufia University Hospital, Shebin El-Kom, Egypt
| | | |
Collapse
|
26
|
Howie S, Bottomley C, Chimah O, Ideh R, Ebruke B, Okomo U, Onyeama C, Donkor S, Rodrigues O, Tapgun M, Janneh M, Oluwalana C, Kuti B, Enwere G, Esangbedo P, Doherty C, Mackenzie G, Greenwood B, Corrah T, Prentice A, Adegbola R, Zaman S. Zinc as an adjunct therapy in the management of severe pneumonia among Gambian children: randomized controlled trial. J Glob Health 2018; 8:010418. [PMID: 29713463 PMCID: PMC5908397 DOI: 10.7189/jogh.08.010418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The benefit of zinc as an adjunct therapy for severe pneumonia is not established. We assessed the benefit of adjunct zinc therapy for severe pneumonia in children and determined whether the study children were zinc deficient. Methods This was a randomized, parallel group, double-blind, placebo-controlled trial with an allocation ratio of 1:1 conducted in children with severe pneumonia to evaluate the efficacy of daily zinc as an adjunct treatment in preventing 'treatment failure' (presence of any sign of severe pneumonia) on day-5 and day-10 and in reducing the time to resolution of signs of severe pneumonia. Six hundred and four children 2-59 months of age presenting with severe pneumonia at six urban and rural health care facilities in The Gambia were individually randomised to receive placebo (n = 301) or zinc (n = 303) for seven days. To determine if the study children were zinc deficient, supplementation was continued in a randomly selected subgroup of 121 children from each arm for six months post-enrolment, and height-gain, nutritional status, plasma zinc concentrations, and immune competence were compared. Results Percentage of treatment failure were similar in placebo and zinc arms both on day 5 (14.0% vs 14.1%) and day 10 (5.2% vs 5.9%). The time to recovery from lower chest wall indrawing and sternal retraction was longer in the placebo compared to zinc arm (24.4 vs 23.0 hours; P = 0.011 and 18.7 vs 11.0 hours; P = 0.006 respectively). The time to resolution for all respiratory symptoms of severity was not significantly different between placebo and zinc arms (42.3 vs 30.9 hours respectively; P = 0.242). In the six months follow-up sub-group, there was no significant difference in height gain, height-for-age and weight-for-height Z-scores, mid upper arm circumference, plasma zinc concentrations, and anergy at six months post-enrolment. Conclusions In this population, zinc given as an adjunct treatment for severe pneumonia showed no benefit in treatment failure rates, or clinically important benefit in time to recovery from respiratory symptoms and showed marginal benefit in rapidity of resolution of some signs of severity. This finding does not support routine use of zinc as an adjunct treatment in severe pneumonia in generally zinc replete children. Trial registration ISRCTN33548493.
Collapse
Affiliation(s)
- Stephen Howie
- Medical Research Council Unit The Gambia, Fajara, Gambia.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | - Readon Ideh
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Bernard Ebruke
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Uduak Okomo
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Simon Donkor
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Mary Tapgun
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Marie Janneh
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Bankole Kuti
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Godwin Enwere
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Conor Doherty
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia, Fajara, Gambia.,London School of Hygiene and Tropical Medicine, London, UK.,Murdoch Childrens Research Institute, Melbourne, Australia
| | | | - Tumani Corrah
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Andrew Prentice
- Medical Research Council Unit The Gambia, Fajara, Gambia.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - Syed Zaman
- Medical Research Council Unit The Gambia, Fajara, Gambia.,London School of Hygiene and Tropical Medicine, London, UK.,Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
27
|
Self-Care for Common Colds: The Pivotal Role of Vitamin D, Vitamin C, Zinc, and Echinacea in Three Main Immune Interactive Clusters (Physical Barriers, Innate and Adaptive Immunity) Involved during an Episode of Common Colds-Practical Advice on Dosages and on the Time to Take These Nutrients/Botanicals in order to Prevent or Treat Common Colds. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:5813095. [PMID: 29853961 PMCID: PMC5949172 DOI: 10.1155/2018/5813095] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/06/2018] [Accepted: 03/26/2018] [Indexed: 02/07/2023]
Abstract
Maintaining a normal healthy immune defense system lowers the incidence and/or the severity of symptoms and/or the duration of common cold (CC). Physical barriers and innate and adaptive immunity have been involved during a CC episode. Vitamins C and D, zinc, and Echinacea have evidence-based efficacy on these immune system barriers. This review includes 82 eligible studies to consider the preventive role of these nutrients in immune clusters and in CC to provide advice on dosage and assumption of these nutrients. Regarding vitamin C, regular supplementation (1 to 2 g/day) has shown that vitamin C reduces the duration (in adults by 8%, in children by 14%) and the severity of CC. Considering zinc, the supplementation may shorten the duration of colds by approximately 33%. CC patients may be instructed to try zinc within 24 hours of onset of symptoms. As for vitamin D, the supplementation protected against CC overall, considering baseline levels and age. Patients with vitamin D deficiency and those not receiving bolus doses experienced the most benefit. Regarding Echinacea, prophylactic treatment with this extract (2400 mg/day) over 4 months appeared to be beneficial for preventing/treating CC. In conclusion, the current evidence of efficacy for zinc, vitamins D and C, and Echinacea is so interesting that CC patients may be encouraged to try them for preventing/treating their colds, although further studies are needed on this topic.
Collapse
|
28
|
Bagri NK, Bagri N, Jana M, Gupta AK, Wadhwa N, Lodha R, Kabra SK, Chandran A, Aneja S, Chaturvedi MK, Sodhi J, Fitzwater SP, Chandra J, Rath B, Kainth US, Saini S, Black RE, Santosham M, Bhatnagar S. Efficacy of Oral Zinc Supplementation in Radiologically Confirmed Pneumonia: Secondary Analysis of a Randomized Controlled Trial. J Trop Pediatr 2018; 64:110-117. [PMID: 28575379 DOI: 10.1093/tropej/fmx036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the effect of zinc as an adjuvant therapy in radiologically confirmed pneumonia in children 2-24 months of age. PATIENTS AND METHODS We analyzed data of 212 children with pneumonia for whom chest X-ray films were available at enrollment and at least two radiologists agreed on the diagnosis of pneumonia. We compared the time to recovery in the two groups (n = 121, zinc group and n = 91, placebo group) using a Cox proportional hazards regression model. RESULTS Time to recovery was similar in both groups [median interquartile range: zinc, 84 h (64, 140 h); placebo, 85 h (65, 140 h)]. The absolute risk reduction for treatment failure was 5.2% (95% confidence interval: -4.8, 15.1) with zinc supplementation. CONCLUSION There was no significant beneficial effect of zinc on the duration of recovery or risk of treatment failure in children with radiologically confirmed pneumonia.
Collapse
Affiliation(s)
- Narendra Kumar Bagri
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Bagri
- Mahajan Imaging, Defence Colony, New Delhi 110024, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nitya Wadhwa
- Department of Pediatrics, All India Institute of Medical Sciences, Centre for Diarrheal Diseases and Nutrition Research, New Delhi 110029, India.,Pediatric Biology Centre, Translational Health Science and Technology Institute, Faridabad, Haryana 121001, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Aruna Chandran
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA.,Department of Pediatrics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | - Satinder Aneja
- Department of Pediatrics, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi 110001, India
| | - Mona K Chaturvedi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jitender Sodhi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sean Patrick Fitzwater
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | - Jagdish Chandra
- Department of Pediatrics, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi 110001, India
| | - Bimbadhar Rath
- Department of Pediatrics, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi 110001, India
| | - Udaypal S Kainth
- Department of Pediatrics, Deen Dayal Upadhyay Hospital, New Delhi 110064, India
| | - Savita Saini
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA.,Department of Pediatrics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA.,Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | - Shinjini Bhatnagar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India.,Department of Pediatrics, All India Institute of Medical Sciences, Centre for Diarrheal Diseases and Nutrition Research, New Delhi 110029, India
| |
Collapse
|
29
|
Carcillo JA, Dean JM, Holubkov R, Berger J, Meert KL, Anand KJS, Zimmerman JJ, Newth CJL, Harrison R, Burr J, Willson DF, Nicholson C, Bell MJ, Berg RA, Shanley TP, Heidemann SM, Dalton H, Jenkins TL, Doctor A, Webster A, Tamburro RF. Interaction Between 2 Nutraceutical Treatments and Host Immune Status in the Pediatric Critical Illness Stress-Induced Immune Suppression Comparative Effectiveness Trial. JPEN J Parenter Enteral Nutr 2017; 41:1325-1335. [PMID: 27660289 PMCID: PMC6103642 DOI: 10.1177/0148607116670377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The pediatric Critical Illness Stress-induced Immune Suppression (CRISIS) trial compared the effectiveness of 2 nutraceutical supplementation strategies and found no difference in the development of nosocomial infection and sepsis in the overall population. We performed an exploratory post hoc analysis of interaction between nutraceutical treatments and host immune status related to the development of nosocomial infection/sepsis. METHODS Children from the CRISIS trial were analyzed according to 3 admission immune status categories marked by decreasing immune competence: immune competent without lymphopenia, immune competent with lymphopenia, and previously immunocompromised. The comparative effectiveness of the 2 treatments was analyzed for interaction with immune status category. RESULTS There were 134 immune-competent children without lymphopenia, 79 previously immune-competent children with lymphopenia, and 27 immunocompromised children who received 1 of the 2 treatments. A significant interaction was found between treatment arms and immune status on the time to development of nosocomial infection and sepsis ( P < .05) and on the rate of nosocomial infection and sepsis per 100 patient days ( P < .05). Whey protein treatment protected immune-competent patients without lymphopenia from infection and sepsis, both nutraceutical strategies were equivalent in immune-competent patients with lymphopenia, and zinc, selenium, glutamine, and metoclopramide treatment protected immunocompromised patients from infection and sepsis. CONCLUSIONS The science of immune nutrition is more complex than previously thought. Future trial design should consider immune status at the time of trial entry because differential effects of nutraceuticals may be related to this patient characteristic.
Collapse
Affiliation(s)
| | | | | | - John Berger
- 3 Children's National Medical Center, Washington, DC, USA
| | | | | | | | | | - Rick Harrison
- 8 Mattel Children's Hospital at University of California, Los Angeles, California, USA
| | - Jeri Burr
- 2 University of Utah, Salt Lake City, Utah, USA
| | | | - Carol Nicholson
- 10 Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Michael J Bell
- 1 Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert A Berg
- 11 Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Heidi Dalton
- 13 Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Tammara L Jenkins
- 10 Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Allan Doctor
- 14 St Louis Children's Hospital, St Louis, Missouri, USA
| | | | - Robert F Tamburro
- 10 Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| |
Collapse
|
30
|
Dao DT, Anez-Bustillos L, Cho BS, Li Z, Puder M, Gura KM. Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities. Nutrients 2017; 9:nu9111185. [PMID: 29143766 PMCID: PMC5707657 DOI: 10.3390/nu9111185] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 02/06/2023] Open
Abstract
Micronutrients refer to a group of organic vitamins and inorganic trace elements that serve many functions in metabolism. Assessment of micronutrient status in critically ill children is challenging due to many complicating factors, such as evolving metabolic demands, immature organ function, and varying methods of feeding that affect nutritional dietary intake. Determination of micronutrient status, especially in children, usually relies on a combination of biomarkers, with only a few having been established as a gold standard. Almost all micronutrients display a decrease in their serum levels in critically ill children, resulting in an increased risk of deficiency in this setting. While vitamin D deficiency is a well-known phenomenon in critical illness and can predict a higher need for intensive care, serum concentrations of many trace elements such as iron, zinc, and selenium decrease as a result of tissue redistribution in response to systemic inflammation. Despite a decrease in their levels, supplementation of micronutrients during times of severe illness has not demonstrated clear benefits in either survival advantage or reduction of adverse outcomes. For many micronutrients, the lack of large and randomized studies remains a major hindrance to critically evaluating their status and clinical significance.
Collapse
Affiliation(s)
- Duy T Dao
- Department of Surgery and Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Lorenzo Anez-Bustillos
- Department of Surgery and Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Bennet S Cho
- Department of Surgery and Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Zhilling Li
- Department of Pharmacy, Shanghai Children's Hospital, Shanghai Jiao Tong University, 355 Luding Road, Shanghai 200062, China.
| | - Mark Puder
- Department of Surgery and Vascular Biology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Kathleen M Gura
- Department of Pharmacy and the Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| |
Collapse
|
31
|
Karim T, Muhit M, Khandaker G. Interventions to prevent respiratory diseases - Nutrition and the developing world. Paediatr Respir Rev 2017; 22:31-37. [PMID: 27793738 DOI: 10.1016/j.prrv.2016.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 01/22/2023]
Abstract
Malnutrition is a major cause of morbidity and mortality in developing countries and nutrition plays a critical role in both acute and chronic respiratory conditions. Inadequacies in the nutritional requirements of a developing lung in utero and in early life can compromise the respiratory system integrity and result in poor lung function, reduced protection against infections, greater likelihood of acute illnesses in childhood and chronic illness in adulthood. Nutritional interventions harness great potential in reducing respiratory illness related morbidity and mortality in the developing world. In this review we have summarized the findings from published systematic reviews/meta-analysis, experimental and observational studies that looked into different nutritional interventions for preventing respiratory diseases in developing countries.
Collapse
Affiliation(s)
- Tasneem Karim
- CSF Global, Dhaka, Bangladesh; Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh; Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Gulam Khandaker
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia.
| |
Collapse
|
32
|
Hasanzadeh Kiabi F, Alipour A, Darvishi-Khezri H, Aliasgharian A, Emami Zeydi A. Zinc Supplementation in Adult Mechanically Ventilated Trauma Patients is Associated with Decreased Occurrence of Ventilator-associated Pneumonia: A Secondary Analysis of a Prospective, Observational Study. Indian J Crit Care Med 2017; 21:34-39. [PMID: 28197049 PMCID: PMC5278588 DOI: 10.4103/0972-5229.198324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the Intensive Care Unit (ICU). The aim of this analysis is to determine potential association between zinc supplementation with the occurrence of VAP in adult mechanically ventilated trauma patients. SUBJECTS AND METHODS This secondary analysis of a prospective observational study was carried out over a period of 1 year in ICUs of one teaching hospital in Iran. A total of 186 adults mechanically ventilated trauma patients, who required at least 48 h of MV and received zinc sulfate supplement (n = 82) or not (n = 104) during their ICU stay, were monitored for the occurrence of VAP until their discharge from the ICU or death. RESULTS Forty-one of 186 patients developed VAP, 29.09 days after admission (95% confidence interval [CI]: 26.27-31.9). The overall incidence of VAP was 18.82 cases per 1000 days of intubation (95% CI: 13.86-25.57). Patients who received zinc sulfate supplement have smaller hazard of progression to VAP than others (hazard ratio: 0.318 [95% CI: 0.138-0.732]; P < 0.0001). CONCLUSION The findings show that zinc supplementation may be associated with a significant reduction in the occurrence of VAP in adult mechanically ventilated trauma patients. Further well-designed randomized clinical trials to confirm the efficacy of this potential preventive modality are warranted.
Collapse
Affiliation(s)
- Farshad Hasanzadeh Kiabi
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Community Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Aily Aliasgharian
- Student Research Committee, Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Emami Zeydi
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
33
|
Green RJ. Viral Lower Respiratory Tract Infections. VIRAL INFECTIONS IN CHILDREN, VOLUME II 2017. [PMCID: PMC7122336 DOI: 10.1007/978-3-319-54093-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lower respiratory tract infections in children are often viral in origin. Unfortunately in this time of significant antimicrobial resistance of infectious organisms, especially bacteria, there is still a tendency for clinicians to manage a child who coughs with antibiotics. In addition, the World Health Organization (WHO) has defined “pneumonia” as a condition that only occurs in children who have “fast breathing or chest wall indrawing”. That would delineate upper respiratory tract infections from those in the lower airway. However, in addition to pneumonia another important entity exists in the lower respiratory tract that is almost always viral in origin. This condition is acute viral bronchiolitis. The concept of “acute lower respiratory tract infection” (ALRTI) has emerged and it is becoming increasing evident from a number of studies that the infectious base of both acute pneumonia (AP) and acute bronchiolitis in children has a mixed etiology of microorganisms. Therefore, whilst certain clinical phenotypes do not require antibiotics the actual microbial etiology is much less distinct.
Collapse
Affiliation(s)
- Robin J. Green
- Department of Paediatrics and Child Health, University of Pretoria, School of Medicine, Pretoria, ZA, South Africa
| |
Collapse
|
34
|
Yazbeck N, Hanna-Wakim R, El Rafei R, Barhoumi A, Farra C, Daher RT, Majdalani M. Dietary Zinc Intake and Plasma Zinc Concentrations in Children with Short Stature and Failure to Thrive. ANNALS OF NUTRITION AND METABOLISM 2016; 69:9-14. [DOI: 10.1159/000447648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022]
Abstract
Background: The burden of zinc deficiency on children includes an increased incidence of diarrhea, failure to thrive (FTT) and short stature. The aim of this study was to assess whether children with FTT and/or short stature have lower dietary zinc intake and plasma zinc concentrations compared to controls. Methods: A case-control study conducted at the American University of Beirut Medical Center included 161 subjects from 1 to 10 years of age. Results: Cases had a statistically significant lower energy intake (960.9 vs. 1,135.2 kcal for controls, p = 0.010), lower level of fat (30.3 vs. 36.5 g/day, p = 0.0043) and iron intake (7.4 vs. 9.1 mg/day, p = 0.034). There was no difference in zinc, copper, carbohydrate and protein intake between the 2 groups. The plasma zinc concentration did not differ between the cases and controls (97.4 vs. 98.2 μg/dl, p = 0.882). More cases had mild-to-moderate zinc deficiency when compared to controls with 10.3 vs. 3.6%, p = 0.095. Conclusion: Our study did not show statistically significant difference in dietary zinc intake and plasma zinc concentrations between children with FTT and/or short stature compared to healthy controls. A prospective study is planned to assess the effect of zinc supplementation on growth parameters in FTT children.
Collapse
|
35
|
Hsieh H, Vignesh KS, Deepe GS, Choubey D, Shertzer HG, Genter MB. Mechanistic studies of the toxicity of zinc gluconate in the olfactory neuronal cell line Odora. Toxicol In Vitro 2016; 35:24-30. [PMID: 27179668 DOI: 10.1016/j.tiv.2016.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 11/15/2022]
Abstract
Zinc is both an essential and potentially toxic metal. It is widely believed that oral zinc supplementation can reduce the effects of the common cold; however, there is strong clinical evidence that intranasal (IN) zinc gluconate (ZG) gel treatment for this purpose causes anosmia, or the loss of the sense of smell, in humans. Using the rat olfactory neuron cell line, Odora, we investigated the molecular mechanism by which zinc exposure exerts its toxic effects on olfactory neurons. Following treatment of Odora cells with 100 and 200μM ZG for 0-24h, RNA-seq and in silico analyses revealed up-regulation of pathways associated with zinc metal response, oxidative stress, and ATP production. We observed that Odora cells recovered from zinc-induced oxidative stress, but ATP depletion persisted with longer exposure to ZG. ZG exposure increased levels of NLRP3 and IL-1β protein levels in a time-dependent manner, suggesting that zinc exposure may cause an inflammasome-mediated cell death, pyroptosis, in olfactory neurons.
Collapse
Affiliation(s)
- Heidi Hsieh
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH 45267-0056, United States
| | | | - George S Deepe
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45267-0557, United States; Veterans Affairs Medical Center, Cincinnati, OH 45220, United States
| | - Divaker Choubey
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH 45267-0056, United States
| | - Howard G Shertzer
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH 45267-0056, United States
| | - Mary Beth Genter
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH 45267-0056, United States.
| |
Collapse
|
36
|
Yuan X, Qian SY, Li Z, Zhang ZZ. Effect of zinc supplementation on infants with severe pneumonia. World J Pediatr 2016; 12:166-9. [PMID: 26684319 DOI: 10.1007/s12519-015-0072-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pneumonia is a common respiratory infectious disease in infancy. Previous work shows controversial results on the benefit of zinc supplementation in patients with pneumonia. We conducted this study to investigate serum zinc status amongst infants with severe pneumonia and the clinical impact that zinc supplementation has on those patients with low serum zinc levels. METHODS This study design was a non-blinded prospective randomized controlled trial. The study is approved by the Ethics Committees of Beijing Children's Hospital. A total of 96 infants diagnosed with severe pneumonia and hospitalized in the pediatric intensive care unit between November 2011 and January 2012 were enrolled. Enrolled patients were divided into low serum zinc and normal serum zinc group. The low serum zinc group was randomized into treatment and control groups. Only the treatment group received zinc supplementation within 48-72 hours after hospitalization. RESULTS The prevalence of zinc deficiency on admission was 76.0%. The low zinc level was most apparent in infants between 1 and 3 months of age. The serum zinc level increased in the zinc treatment group and returned to a normal level (median, 53.20 μmol/L) on day 12±2. There was no statistical difference in the pediatric critic illness score, lung injury score, length of hospital stay, and duration of mechanical ventilation between the zinc treatment group and control group. CONCLUSION Zinc deficiency is common in infants with severe pneumonia. Normalization of zinc levels with zinc supplementation did not improve clinical outcomes of infants with pneumonia.
Collapse
Affiliation(s)
- Xiao Yuan
- Pediatric Department of Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Su-Yun Qian
- PICU, Beijing Children's Hospital, Capital Medical University, Beijing, China.
- PICU, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
| | - Zheng Li
- PICU, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhe-Zhe Zhang
- PICU, Beijing Children's Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
37
|
Barnett JB, Dao MC, Hamer DH, Kandel R, Brandeis G, Wu D, Dallal GE, Jacques PF, Schreiber R, Kong E, Meydani SN. Effect of zinc supplementation on serum zinc concentration and T cell proliferation in nursing home elderly: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2016; 103:942-51. [PMID: 26817502 DOI: 10.3945/ajcn.115.115188] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 12/15/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Zinc is essential for the regulation of immune response. T cell function declines with age. Zinc supplementation has the potential to improve the serum zinc concentrations and immunity of nursing home elderly with a low serum zinc concentration. OBJECTIVE We aimed to determine the effect of supplementation with 30 mg Zn/d for 3 mo on serum zinc concentrations of zinc-deficient nursing home elderly. DESIGN This was a randomized, double-blind, placebo-controlled study. Of 53 nursing home elderly (aged ≥65 y) who met eligibility criteria, 58% had a low serum zinc concentration (serum zinc <70 μg/dL); these 31 were randomly assigned to zinc (30 mg Zn/d) (n = 16) or placebo (5 mg Zn/d) (n = 15) groups. The primary outcome measure was change in serum zinc concentrations between baseline and month 3. We also explored the effects of supplementation on immune response. RESULTS Baseline characteristics were similar in the 2 groups. The difference in the mean change in serum zinc was significantly higher, by 16%, in the zinc group than in the placebo group (P = 0.007) when baseline zinc concentrations were controlled for. In addition, controlling for baseline C-reactive protein, copper, or albumin did not change the results. However, supplementation of participants with ≤60 μg serum Zn/dL failed to increase their serum zinc to ≥70 μg/dL. Zinc supplementation also significantly increased anti-CD3/CD28 and phytohemagglutinin-stimulated T cell proliferation, and the number of peripheral T cells (P < 0.05). When proliferation was expressed per number of T cells, the significant differences between groups were lost, suggesting that the zinc-induced enhancement of T cell proliferation was mainly due to an increase in the number of T cells. CONCLUSIONS Zinc supplementation at 30 mg/d for 3 mo is effective in increasing serum zinc concentrations in nursing home elderly; however, not all zinc-deficient elderly reached adequate concentrations. The increase in serum zinc concentration was associated with the enhancement of T cell function mainly because of an increase in the number of T cells.
Collapse
Affiliation(s)
- Junaidah B Barnett
- Nutritional Immunology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Maria C Dao
- Nutritional Immunology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Davidson H Hamer
- Nutritional Immunology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA; Section of Infectious Diseases and Center for Global Health and Development and Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Ruth Kandel
- Hebrew SeniorLife, Roslindale, MA; and Harvard Medical School, Boston, MA
| | - Gary Brandeis
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Dayong Wu
- Nutritional Immunology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Gerard E Dallal
- Nutritional Immunology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Paul F Jacques
- Nutritional Immunology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Robert Schreiber
- Hebrew SeniorLife, Roslindale, MA; and Harvard Medical School, Boston, MA
| | - Eunhee Kong
- Nutritional Immunology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Simin N Meydani
- Nutritional Immunology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA;
| |
Collapse
|
38
|
Zinc as an adjunct to antibiotics for the treatment of severe pneumonia in children <5 years: a meta-analysis of randomised-controlled trials. Br J Nutr 2016; 115:807-16. [PMID: 26811108 DOI: 10.1017/s0007114515005449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The effect of Zn, as an adjunct to antibiotics, on the treatment of severe pneumonia in young children is still under debate; therefore, we performed a meta-analysis to evaluate the therapeutic role of Zn for severe pneumonia in children younger than 5 years. PubMed, Cochrane library and Embase databases were systematically searched from inception until October 2015 for randomised-controlled trials (RCT) that assessed the effect of Zn as an adjunct to antibiotics for severe pneumonia. Random-effects model was used for calculating the pooled estimates, and intention-to-treat principle was also applied. Nine RCT involving 2926 children were included. Overall, the pooled results showed that adjunct treatment with Zn failed to reduce the time to recovery from severe pneumonia (hazard ratios (HR)=1·04; 95% CI 0·90, 1·19; I(2)=39%; P=0·58), hospital length of stay (HR=1·04; 95% CI 0·83, 1·33; I(2)=57%; P=0·74), treatment failure (relative risk (RR)=0·95; 95% CI 0·79, 1·14; I(2)=20%; P=0·58) or change of antibiotics (RR=1·07; 95% CI 0·79, 1·45; I(2)=44%; P=0·67). In addition, continuous outcomes were consistent while meta-analysed with standard mean difference, and all outcomes remained stable in intention-to-treat analysis. No significant differences were observed in the two groups between death rate, adverse events or recovery times of severe pneumonia indicators. Our results suggested that adjunct treatment with Zn failed to benefit young children in the treatment of severe pneumonia. Considering the clinical heterogeneity, baseline characteristics of children, definition of severe pneumonia and Zn supplement way should be taken into consideration in future research. This study was registered at PRESPERO as CRD42015019798.
Collapse
|
39
|
Raiten DJ, Sakr Ashour FA, Ross AC, Meydani SN, Dawson HD, Stephensen CB, Brabin BJ, Suchdev PS, van Ommen B. Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE). J Nutr 2015; 145:1039S-1108S. [PMID: 25833893 PMCID: PMC4448820 DOI: 10.3945/jn.114.194571] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/08/2014] [Accepted: 10/29/2014] [Indexed: 02/06/2023] Open
Abstract
An increasing recognition has emerged of the complexities of the global health agenda—specifically, the collision of infections and noncommunicable diseases and the dual burden of over- and undernutrition. Of particular practical concern are both 1) the need for a better understanding of the bidirectional relations between nutritional status and the development and function of the immune and inflammatory response and 2) the specific impact of the inflammatory response on the selection, use, and interpretation of nutrient biomarkers. The goal of the Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE) is to provide guidance for those users represented by the global food and nutrition enterprise. These include researchers (bench and clinical), clinicians providing care/treatment, those developing and evaluating programs/interventions at scale, and those responsible for generating evidence-based policy. The INSPIRE process included convening 5 thematic working groups (WGs) charged with developing summary reports around the following issues: 1) basic overview of the interactions between nutrition, immune function, and the inflammatory response; 2) examination of the evidence regarding the impact of nutrition on immune function and inflammation; 3) evaluation of the impact of inflammation and clinical conditions (acute and chronic) on nutrition; 4) examination of existing and potential new approaches to account for the impact of inflammation on biomarker interpretation and use; and 5) the presentation of new approaches to the study of these relations. Each WG was tasked with synthesizing a summary of the evidence for each of these topics and delineating the remaining gaps in our knowledge. This review consists of a summary of the INSPIRE workshop and the WG deliberations.
Collapse
Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD;
| | - Fayrouz A Sakr Ashour
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD
| | - A Catharine Ross
- Departments of Nutritional Sciences and Veterinary and Biomedical Science and Center for Molecular Immunology and Infectious Disease, Pennsylvania State University, University Park, PA
| | - Simin N Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Harry D Dawson
- USDA-Agricultural Research Service, Beltsville Human Nutrition Research Center, Diet, Genomics, and Immunology Laboratory, Beltsville, MD
| | - Charles B Stephensen
- Agricultural Research Service, Western Human Nutrition Research Center, USDA, Davis, CA
| | - Bernard J Brabin
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Parminder S Suchdev
- Department of Pediatrics and Global Health, Emory University, Atlanta, GA; and
| | | |
Collapse
|
40
|
Cvijanovich NZ, King JC, Flori HR, Gildengorin G, Vinks AA, Wong HR. Safety and Dose Escalation Study of Intravenous Zinc Supplementation in Pediatric Critical Illness. JPEN J Parenter Enteral Nutr 2015; 40:860-8. [PMID: 25700179 DOI: 10.1177/0148607115572193] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/24/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Critically ill children have low plasma zinc (pZn), correlating with organ failure. Since Zn influences inflammation, immune function, and glucose control, Zn supplementation is a plausible therapeutic modality. We sought to determine a safe dose of intravenous (IV) Zn to restore pZn in critically ill children. METHODS Stepwise dose escalation study of IV Zn supplementation at a tertiary children's hospital. All children (<10 years) admitted to the pediatric intensive care unit with a Pediatric Risk of Mortality III score >5, or ≥1 new organ failure were eligible. After consent, patients were sequentially enrolled into 4 dosing groups: (1) no zinc, (2) Zn250: 250 mcg/kg/d ZnSO4, (3) Zn500: 500 mcg/kg/d ZnSO4, or (4) Zn750: 750 mcg/kg/d ZnSO4 ZnSO4 was administered 3 times daily for 7 days. pZn was measured at baseline, end of first ZnSO4 infusion, 1 hour postinfusion, and 7 hours postinfusion on day 1, then daily through days 2-7. Interleukin-6 (IL-6), C-reactive protein (CRP), and lymphocyte subsets were measured on days 1 and 3. Glucose was measured 3 times daily for 7 days. RESULTS Twenty-four patients were enrolled. Baseline demographics were similar among groups. Baseline pZn was low in all patients (mean [SD], 41.8 [16.0] mcg/dL). pZn increased over the study period in supplemented groups; however, mean pZn in the Zn750 group exceeded the 50th percentile. pZn was not associated with IL-6, CRP, or lymphocyte subsets among groups. Degree of hyperglycemia did not differ among groups. No patient had a study-related adverse event. CONCLUSIONS IV zinc supplementation at 500 mcg/kg/d restores pZn to near the 50th percentile and is well tolerated.
Collapse
Affiliation(s)
- Natalie Z Cvijanovich
- Division of Critical Care, Children's Hospital and Research Center Oakland, Oakland, California, USA
| | - Janet C King
- Children's Hospital Oakland Research Institute, Oakland, California, USA
| | - Heidi R Flori
- Division of Critical Care, Children's Hospital and Research Center Oakland, Oakland, California, USA
| | - Ginny Gildengorin
- Children's Hospital Oakland Research Institute, Oakland, California, USA
| | - Alexander A Vinks
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Hector R Wong
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
41
|
Basnet S, Mathisen M, Strand TA. Oral zinc and common childhood infections--An update. J Trace Elem Med Biol 2015; 31:163-6. [PMID: 24906347 DOI: 10.1016/j.jtemb.2014.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/07/2014] [Accepted: 05/14/2014] [Indexed: 11/27/2022]
Abstract
Zinc is an essential micronutrient important for growth and for normal function of the immune system. Many children in developing countries have inadequate zinc nutrition. Routine zinc supplementation reduces the risk of respiratory infections and diarrhea, the two leading causes of morbidity and mortality in young children worldwide. In childhood diarrhea oral zinc also reduces illness duration and risk of persistent episodes. Oral zinc is therefore recommended for the treatment of acute diarrhea in young children. The results from the studies that have measured the therapeutic effect of zinc on acute respiratory infections, however, are conflicting. Moreover, the results of therapeutic zinc for childhood malaria also are so far not promising.This paper gives a brief outline of the current evidence from clinical trials on therapeutic effect of oral zinc on childhood respiratory infections, pneumonia and malaria and also of new evidence of the effect on serious bacterial illness in young infants.
Collapse
Affiliation(s)
- Sudha Basnet
- Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; Centre for International Health, University of Bergen, Bergen, Norway.
| | - Maria Mathisen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromso, Norway
| | - Tor A Strand
- Centre for International Health, University of Bergen, Bergen, Norway; Division of Laboratory Medicine, Sykehuset Innlandet, Lillehammer, Norway
| |
Collapse
|
42
|
Ernst J, Ettyang G, Neumann CG. High-nutrition biscuits to increase animal protein in diets of HIV-infected Kenyan women and their children: a study in progress. Food Nutr Bull 2014; 35:S198-204. [PMID: 25639139 PMCID: PMC4459502 DOI: 10.1177/15648265140354s306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preliminary evidence suggests that improved nutrition early in HIV infection may delay progression to AIDS and delay the initiation or improve the effectiveness of antiretroviral drug therapy. There are few studies that evaluate food-based interventions in drug-naïve, HIV-infected women and their children. Meat provides several nutrients identified as important in maintaining immune function and lean body mass. OBJECTIVE To design supplemental meat and soybean biscuits for use in a randomized trial examining the effect of meat in the diet of drug-naïve, HIV-infected rural Kenyan women on changes in weight, lean body mass, morbidity, nutritional status, and activities of daily living of the women and growth and development of their children. METHODS We designed three supplemental biscuits: one with added dried beef another with added soybean flour, and a wheat biscuit to serve as a control biscuit to be used in a randomized feeding intervention in drug-naïve, HIV-infected rural Kenyan women and their children. The nutritional contents of the different types of biscuit were examined and compared. RESULTS The three biscuits were isocaloric. Meat biscuits provided more lysine, vitamin B12, and bioavailable zinc. Soybean biscuits provided more total and absorbable iron; however, higher fiber and phytate contents may inhibit nutrient absorption. Data analysis for clinical outcomes of the trial is ongoing. CONCLUSIONS The "biscuit model" is useful for nutrition supplementation studies because it can be provided in a blinded and randomized fashion, safely and privately in a home under directly observed consumption by a highly stigmatized population. It is well received by adults and children, and the biscuits can be produced locally with available, simple, affordable technology.
Collapse
|
43
|
Fink G, Heitner J. Evaluating the cost-effectiveness of preventive zinc supplementation. BMC Public Health 2014; 14:852. [PMID: 25128210 PMCID: PMC4143582 DOI: 10.1186/1471-2458-14-852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/06/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Even though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions. METHODS Using the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc supplementation in a representative low-income country. We then computed the cost and cost-effectiveness for three delivery mechanisms: the direct distribution of zinc supplements, the distribution of micronutrient biscuits including zinc, and the distribution of zinc through water filtration systems. RESULTS Combining all health outcomes and impact estimates, we find that systematic zinc supplementation among children of ages one to five would avert 1.423 DALYs per 100 households and year in least developed countries. The estimated cost per DALY is US$ 606 for pill supplementation, US$ 1211 for micronutrient biscuits, and US$ 879 per DALY saved for water filtration systems. CONCLUSIONS Preventive zinc supplementation to children of ages 1-5 appears to be a highly cost-effective intervention in typical developing country settings. More research will be needed to determine the most effective mechanism to deliver zinc to this target population.
Collapse
Affiliation(s)
- Günther Fink
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, 02115 Boston, MA USA
| | - Jesse Heitner
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, 02115 Boston, MA USA
| |
Collapse
|
44
|
Abstract
BACKGROUND Otitis media is inflammation of the middle ear and is usually caused by infection. It affects people of all ages but is particularly common in young children. Around 164 million people worldwide have long-term hearing loss caused by this condition, 90% of them in low-income countries. As zinc supplements prevent pneumonia in disadvantaged children, we wanted to investigate whether zinc supplements could also prevent otitis media. OBJECTIVES To evaluate whether zinc supplements prevent otitis media in adults and children of different ages. SEARCH METHODS We searched CENTRAL (2014, Issue 1), MEDLINE (1950 to February week 4, 2014) and EMBASE (1974 to March 2014). SELECTION CRITERIA Randomised, placebo-controlled trials of zinc supplements given at least once a week for at least a month for preventing otitis media. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility and methodological quality of the included trials and extracted and analysed data. We summarised results using risk ratios (RRs) or rate ratios for dichotomous data and mean differences (MDs) for continuous data. We combined trial results where appropriate. MAIN RESULTS No new trials were identified for inclusion in this update. We identified 12 trials for inclusion, 10 of which contributed outcomes data. There were a total of 6820 participants. In trials of healthy children living in low-income communities, two trials did not demonstrate a significant difference between the zinc-supplemented and placebo groups in the numbers of participants experiencing an episode of definite otitis media during follow-up (3191 participants); another trial showed a significantly lower incidence rate of otitis media in the zinc group (rate ratio 0.69, 95% confidence interval (CI) 0.61 to 0.79, n = 1621). A small trial of 39 infants undergoing treatment for severe malnutrition suggested a benefit of zinc for the mean number of episodes of otitis media (mean difference (MD) -1.12 episodes, 95% CI -2.21 to -0.03). Zinc supplements did not seem to cause any serious adverse events but a small minority of children were reported to have vomited shortly after ingestion of the supplements. The trial evidence included is generally of good quality, with a low risk of bias. AUTHORS' CONCLUSIONS Evidence on whether zinc supplementation can reduce the incidence of otitis media in healthy children under the age of five years living in low- and middle-income countries is mixed. There is some evidence of benefit in children being treated for marasmus (severe malnutrition), but this is based on one small trial and should therefore be treated with caution.
Collapse
Affiliation(s)
- Anjana Gulani
- Max Multispeciality CentreDepartment of PediatricsN‐110, Panchsheel ParkNew DelhiIndia110017
- Max Superspeciality HospitalDepartment of Pediatrics and NeonatologySaketNew DelhiIndia
| | - Harshpal S Sachdev
- Sitaram Bhartia Institute of Science and ResearchDepartment of Pediatrics and Clinical EpidemiologyB‐16 Qutab Institutional AreaNew DelhiIndia110016
| | | |
Collapse
|
45
|
Kaur K, Gupta R, Saraf SA, Saraf SK. Zinc: The Metal of Life. Compr Rev Food Sci Food Saf 2014; 13:358-376. [PMID: 33412710 DOI: 10.1111/1541-4337.12067] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 02/05/2014] [Indexed: 01/15/2023]
Abstract
The importance of zinc was 1st reported for Aspergillus niger. It took over 75 y to realize that zinc is also an essential trace element for rats, and an additional 30 y went by before it was recognized that this was also true for humans. The adult body contains about 2 to 3 g of zinc. Zinc is found in organs, tissues, bones, fluids, and cells. It is essential for many physiological functions and plays a significant role in a number of enzyme actions in the living systems. Bioinformatics estimates report that 10% of the human proteome contains zinc-binding sites. Based on its role in such a plethora of cellular components, zinc has diverse biological functions from enzymatic catalysis to playing a crucial role in cellular neuronal systems. Thus, based on the various published studies and reports, it is pertinent to state that zinc is one of the most important essential trace metals in human nutrition and lifestyle. Its deficiency may severely affect the homeostasis of a biological system. This review compiles the role of zinc in prophylaxis/therapeutics and provides current information about its effect on living beings.
Collapse
Affiliation(s)
- Kuljeet Kaur
- Faculty of Pharmacy, Babu Banarasi Das Natl. Inst. of Technology and Management (BBD Univ.), Lucknow, India
| | - Rajiv Gupta
- Faculty of Pharmacy, Babu Banarasi Das Natl. Inst. of Technology and Management (BBD Univ.), Lucknow, India
| | - Shubhini A Saraf
- Dept. of Pharmaceutical Sciences, SB&BT, Babasaheb Bhimrao Ambedkar Univ., Lucknow, India
| | - Shailendra K Saraf
- Faculty of Pharmacy, Babu Banarasi Das Northern India Inst. of Technology, Lucknow, India
| |
Collapse
|
46
|
Desai SN, Cravioto A, Sur D, Kanungo S. Maximizing protection from use of oral cholera vaccines in developing country settings: an immunological review of oral cholera vaccines. Hum Vaccin Immunother 2014; 10:1457-65. [PMID: 24861554 PMCID: PMC5396246 DOI: 10.4161/hv.29199] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/30/2014] [Accepted: 05/10/2014] [Indexed: 11/19/2022] Open
Abstract
When oral vaccines are administered to children in lower- and middle-income countries, they do not induce the same immune responses as they do in developed countries. Although not completely understood, reasons for this finding include maternal antibody interference, mucosal pathology secondary to infection, malnutrition, enteropathy, and previous exposure to the organism (or related organisms). Young children experience a high burden of cholera infection, which can lead to severe acute dehydrating diarrhea and substantial mortality and morbidity. Oral cholera vaccines show variations in their duration of protection and efficacy between children and adults. Evaluating innate and memory immune response is necessary to understand V. cholerae immunity and to improve current cholera vaccine candidates, especially in young children. Further research on the benefits of supplementary interventions and delivery schedules may also improve immunization strategies.
Collapse
Affiliation(s)
| | | | - Dipika Sur
- National Institute of Cholera and Enteric Diseases; Kolkata, India
| | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases; Kolkata, India
| |
Collapse
|
47
|
Qasemzadeh MJ, Fathi M, Tashvighi M, Gharehbeglou M, Yadollah-Damavandi S, Parsa Y, Rahimi E. The effect of adjuvant zinc therapy on recovery from pneumonia in hospitalized children: a double-blind randomized controlled trial. SCIENTIFICA 2014; 2014:694193. [PMID: 24955282 PMCID: PMC4052786 DOI: 10.1155/2014/694193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/16/2014] [Accepted: 04/27/2014] [Indexed: 06/03/2023]
Abstract
Objectives. Pneumonia is one of the common mortality causes in young children. Some studies have shown beneficial effect of zinc supplements on treatment of pneumonia. The present study aimed to investigate the effects of short courses of zinc administration on recovery from this disease in hospitalized children. Methods. In a parallel Double-Blind Randomized Controlled Trial at Ayatollah Golpaygani Hospital in Qom, 120 children aged 3-60 months with pneumonia were randomly assigned 1 : 1 to receive zinc or placebo (5 mL every 12 hours) along with the common antibiotic treatments until discharge. Primary outcome was recovery from pneumonia which included the incidence and resolving clinical symptoms and duration of hospitalization. Results. The difference between two groups in all clinical symptoms at admittance and the variables affecting the disease such as age and sex were not statistically significant (P < 0.05) at baseline. Compared to the placebo group, the treatment group showed a statistically significant decrease in duration of clinical symptoms (P = 0.044) and hospitalization (P = 0.004). Conclusions. Supplemental administration of zinc can expedite the healing process and results in faster resolution of clinical symptoms in children with pneumonia. In general, zinc administration, along with common antibiotic treatments, is recommended in this group of children. It can also reduce the drug resistance caused by multiple antibiotic therapies. This trial is approved by Medical Ethic Committee of Islamic Azad University in Iran (ID Number: 8579622-Q). This study is also registered in AEARCTR (The American Economic Association's Registry for Randomized Controlled Trials). This trial is registered with RCT ID: AEARCTR-0000187.
Collapse
Affiliation(s)
| | - Mahdi Fathi
- Department of Medicine, Islamic Azad University, Qom Branch, Qom, Iran
| | - Maryam Tashvighi
- Department of Medicine, Islamic Azad University, Qom Branch, Qom, Iran
| | | | | | - Yekta Parsa
- Students' Research Committee, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Ebrahim Rahimi
- School of Public Heath, Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
48
|
Scientific Opinion on the substantiation of a health claim related to zinc and normal function of the immune system pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
49
|
Fataki MR, Kisenge RR, Sudfeld CR, Aboud S, Okuma J, Mehta S, Spiegelman D, Fawzi WW. Effect of zinc supplementation on duration of hospitalization in Tanzanian children presenting with acute pneumonia. J Trop Pediatr 2014; 60:104-11. [PMID: 24194421 PMCID: PMC3967446 DOI: 10.1093/tropej/fmt089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Zinc supplementation prevents incident pneumonia in children; however, the effect for pneumonia treatment remains unclear. METHODS A randomized, double-blind, placebo-controlled trial of zinc supplements (daily 25 mg) adjunct to antibiotic treatment of radiology-confirmed acute pneumonia was conducted among hospitalized children (6-36 months) in Dar es Salaam, Tanzania. RESULTS The trial was stopped early due to low enrollment, primarily owing to exclusion of children outside the age range and >3 days of prior illness. Among children enrolled (n = 94), zinc supplementation indicated no beneficial effect on the duration of hospitalization (IRR: 0.69; 95% CI 0.45-1.06; p = 0.09) or the proportion of children who were hospitalized for <3 days (RR: 0.85; 95% CI: 0.57-1.25; p = 0.40) or <5 days (RR: 1.01; 95% CI: 0.83-1.23; p = 0.92) (IRRs and RRs >1.0 favor zinc). CONCLUSIONS Although underpowered, this randomized trial provided no evidence for a beneficial effect of zinc supplementation adjunct to antibiotics for hospitalized children.
Collapse
Affiliation(s)
- Maulidi R. Fataki
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rodrick R. Kisenge
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - James Okuma
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850, USA
| | - Donna Spiegelman
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
| | - Wafaie W. Fawzi
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA
| |
Collapse
|
50
|
Environmental attributes to respiratory diseases of small ruminants. Vet Med Int 2014; 2014:853627. [PMID: 24782941 PMCID: PMC3981018 DOI: 10.1155/2014/853627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/13/2014] [Accepted: 02/15/2014] [Indexed: 02/06/2023] Open
Abstract
Respiratory diseases are the major disease crisis in small ruminants. A number of pathogenic microorganisms have been implicated in the development of respiratory disease but the importance of environmental factors in the initiation and progress of disease can never be overemphasized. They irritate the respiratory tree producing stress in the microenvironment causing a decline in the immune status of the small ruminants and thereby assisting bacterial, viral, and parasitic infections to break down the tissue defense barriers. Environmental pollutants cause acute or chronic reactions as they deposit on the alveolar surface which are characterized by inflammation or fibrosis and the formation of transitory or persistent tissue manifestation. Some of the effects of exposures may be immediate, whereas others may not be evident for many decades. Although the disease development can be portrayed as three sets of two-way communications (pathogen-environment, host-environment, and host-pathogen), the interactions are highly variable. Moreover, the environmental scenario is never static; new compounds are introduced daily making a precise evaluation of the disease burden almost impossible. The present review presents a detailed overview of these interactions and the ultimate effect on the respiratory health of sheep and goat.
Collapse
|