Zinc absorption from zinc oxide, zinc sulfate, zinc oxide + EDTA, or sodium-zinc EDTA does not differ when added as fortificants to maize tortillas

Influence of the Addition of Zinc Oxide Nanoparticles to Cryopreservation Medium for Dog Epididymal Spermatozoa

The purpose of this study was to assess the effect of different concentrations of zinc oxide nanoparticles (ZnONPs) introduced to an extender for frozen-thawed epididymal dog spermatozoa. Epididymides from 22 castrated dogs were minced and cultured in a Tris buffer. The recovered spermatozoa were diluted in Tris-Citric acid-Fructose (TCF) extender with different concentrations of ZnONPs (100 and 200 µg/mL) and control (0.0 µg/mL). Diluted samples were equilibrated at 5 °C for 2 hours before being packed in 0.25 mL straws and stored in liquid nitrogen (-196 °C). After thawing at 37°C for 30 seconds, sperm motility, viability, membrane integrity, acrosome integrity, DNA integrity, and lipid peroxidation by malondialdehyde (MDA) concentration were all measured. The results were presented as mean ± SEM. Adding 100 and 200 µg/mL ZnONPs to the cryopreservation medium significantly (P < .05) improved motility and membrane integrity compared to the control. Viability and acrosome integrity were considerably (P < .05) better at 100 µg/mL ZnONPs than at 200 µg/mL ZnONPs and the control. MDA concentration was significantly (P < .05) decreased at 100 µg/mL ZnONPs compared to 200 µg/mL ZnONPs and the control. When 100 µg/mL ZnONPs were compared to 200 µg/mL ZnONPs and the control, the percentage of DNA damage was significantly (P < .05) reduced. Consequently, adding 100 µg/mL ZnONPs to TCF extender resulted in a significant increase in the proportion of motility, viability, membrane-intact, and acrosome-intact dog epididymal sperm, as well as the preservation of DNA integrity and the prevention of lipid peroxidation at the membrane level.

Reconsidering the Tolerable Upper Levels of Zinc Intake among Infants and Young Children: A Systematic Review of the Available Evidence

Safe upper levels (UL) of zinc intake for children were established based on either (1) limited data from just one study among children or (2) extrapolations from studies in adults. Resulting ULs are less than amounts of zinc consumed by children in many studies that reported benefits of zinc interventions, and usual dietary zinc intakes often exceed the UL, with no apparent adverse effects. Therefore, existing ULs may be too low. We conducted a systematic bibliographic review of studies among preadolescent children, in which (1) additional zinc was provided vs. no additional zinc provided, and (2) the effect of zinc on serum or plasma copper, ceruloplasmin, ferritin, transferrin receptor, lipids, or hemoglobin or erythrocyte super-oxide dismutase were assessed. We extracted data from 44 relevant studies with 141 comparisons. Meta-analyses found no significant overall effect of providing additional zinc, except for a significant negative effect on ferritin (p = 0.001), albeit not consistent in relation to the zinc dose. Interpretation is complicated by the significant heterogeneity of results and uncertainties regarding the physiological and clinical significance of outcomes. Current zinc ULs should be reassessed and potentially revised using data now available for preadolescent children and considering challenges regarding interpretation of results.

Maximising the bioaccessibility of iron and zinc of a complementary food mix through multiple strategies

The investigation was undertaken to maximise the bioaccessibility of iron and zinc of a complementary food mix by multiple approaches of dephytinisation and addition of organic acids. A wheat, pulse and oilseed protein flour mix was dephytinized by phytase activation and different thermal treatments. As the mineral content of the mix was low, the spray dried mix was fortified with different iron and zinc salts to identify the salt with the highest bioaccessibility in this matrix. Based on the percent bioaccessibility, the mix with sodium iron EDTA and zinc oxide was chosen for fortification. Bioaccessibility was enhanced by the addition of fruit powders and pure organic acids. Fruit powders showed a significant increase, but citric acid at a higher dose was beneficial in enhancing bioaccessible iron. The strategy of dephytinisation followed by fortification and the addition of fruit powders or organic acids is promising in alleviating iron and zinc deficiencies.

Suspected hemolytic anemia secondary to acute zinc toxicity after ingestion of "max strength" (zinc oxide) diaper rash cream

OBJECTIVE

To describe the clinical presentation of a dog with hemolytic anemia secondary to zinc toxicosis after 1-week use of "max strength" 40% diaper rash cream.

CASE SUMMARY

A 2-year-old female neutered Maltese presented for vomiting, lethargy, pigmenturia, and pale mucous membranes. "Max Strength" zinc oxide cream had been applied to the patient daily for a week prior to presentation. Clinical examination revealed light pink to pale mucous membranes and tachycardia. Hematology demonstrated large numbers of spherocytes and a strongly regenerative anemia. Plasma zinc concentrations were markedly increased. A diagnosis of hemolytic anemia secondary to subacute zinc toxicosis was made and supportive therapy was instigated. The patient ultimately recovered uneventfully. Acute or subacute zinc toxicosis resulting in hemolytic anemia is not frequently observed, and this case was also unusual in that the zinc source was diaper cream, which historically has been thought to require very large quantities to cause toxicosis.

NEW OR UNIQUE INFORMATION PROVIDED

To the authors' knowledge, there is only one previously reported case of hemolytic anemia secondary to diaper cream use in a hospital setting but no previous reports involving toxicosis secondary to prolonged application at home by owners. Most commercial diaper creams contain zinc oxide, which historically was thought to have poor gastrointestinal absorption and would require a large quantity to cause significant toxicosis and hemolytic anemia. Moreover, this case emphasizes the potential risks associated with zinc oxide cream use, the significance of client education if using these creams, as well as the importance of history in elucidating the underlying cause of hemolytic anemia.

Novel approach for biosynthesizing of zinc oxide nanoparticles using Lactobacillus gasseri and their influence on microbiological, chemical, sensory properties of integrated yogurt

This research aimed to biosynthesizing zinc oxide nanoparticles (ZnO-NPs) using lactobacilli strains. All tested lactobacilli able to biosynthesis ZnO-NPs indicated by white precipitates. The characteristics of the biosynthesis ZnO-NPs from Lactobacillus gasseri were studied using UV-visible spectroscopy, TEM, SEM, DLS, FT-IR, XRD, and antimicrobial activity. The characteristic examination depicted cubic structures, pure and spherical ZnO-NPs with a diameter size of 22 nm. Antimicrobial study of ZnO-NPs displayed better higher antimicrobial activity on food pathogens in a dose-dependent manner. Moreover, integrated biosynthesis ZnO-NPs in yogurt positively affected the shelf life of yogurt during storage for four weeks without changes in the sensory evaluation. The microbiological population of fortified yogurt significantly reduced during storage than control. But chemically evaluation of fortified yogurt indicated an increase in dry matter, protein, and ash content than control. The achieved results suggested that the low amount of biosynthesized ZnO-NPs lead to the development of properties of integrated yogurt. Furthermore, the biosynthesized ZnO-NPs additive to yogurt could be a good food source for groups suffering from zinc deficiency such as the elderly groups or vegetarians who do not eat meat and at risk of zinc inadequacy.

Effectiveness of micronutrient-fortified rice consumption on anaemia and zinc status among vulnerable women in Bangladesh

Micronutrient deficiency is one of the biggest public health concerns in Bangladesh. As per World Health Organisation (WHO) in the 2016 report, 40% women of reproductive age suffer from anaemia. According to the National Micronutrient Survey 2011–2012, 57% women suffer from zinc deficiency. The objective of the present study was to determine the effectiveness of fortified rice (FFR in addressing anaemia and zinc deficiency among vulnerable women. Baseline and endline surveys were conducted among female Vulnerable Group Development (VDG) beneficiaries in five districts in Bangladesh before and after 12 months of FFR distribution. The intervention group received 30 kg FFR; the control group received 30 kg non-FFR for every month from January 2013 to December 2013. The sample sizes were 870 women (435/group) at baseline and 800 (400/group) at endline. Difference-in-difference (DID) was estimated to measure the effect of FFR on anaemia and serum zinc. In the baseline survey, 39% of the FFR group and 34% of the non-FFR group had anaemia. At endline, 34% of women in the FFR group were anaemic compared to 40.7% in the non-FFR group. At endline, prevalence of anaemia was reduced in the FFR group by 4.8% but increased in the non-FFR group by 6.7%. The DID estimation showed the reduction in anaemia after 12 months of FFR consumption was significant (p = 0.035). The DID in mean haemoglobin level after 12 months of FFR consumption was also statistically significant (p = 0.002). Zinc deficiency decreased by 6% in the FFR group at endline, though the DID was not significant. Most of the respondents of the FFR group reported that they received their entitled rice on a regular basis however only half of the non-FFR respondents received every month in 12 months. Anaemia was significantly associated with not consuming fortified rice, geographical region, older age and heavy menstrual bleeding (P<0.05). FFR reduced anaemia and zinc deficiency prevalence. Replacement of regular rice with FFR in the VGD programme is recommended to reduce anaemia among vulnerable groups.

Zinc Absorption from Fortified Milk Powder in Adolescent Girls

Zinc (Zn) is essential for development, growth, and reproduction. The Mexican government subsidizes micronutrient-fortified milk for risk groups, with positive effect on the targeted groups' plasma Zn level, inferring a good absorption is achieved although it has not being measured. The aim of this study was to determine the impact of micronutrient-fortified milk intake during 27 days on Zn absorption in adolescent girls from northwest Mexico. Therefore, Zn absorption was evaluated in 14 healthy adolescent girls (14.1 years old) with adequate plasma Zn levels, before and after 27 days of fortified Zn milk intake. Fractional Zn absorption (FZA) was calculated from urinary ratios of stable isotopic Zn tracers administered orally and intravenously on days 0 and 27, and total absorbed Zn (TZA) was calculated. At the beginning, Zn intake was 6.8 ± 0.85 mg/d (mean ± SE), and 50 % of the adolescent girls did not achieve their requirement (7.3 mg/d). Additionally, FZA was negatively correlated with Zn intake (r =-0.61, p = 0.02), while TZA (1.06 mg/d) was insufficient to cover the physiologic requirements of adolescent girls (3.02 mg/d). At the end of the intervention, all the girls reached the Zn intake recommendation and TZA, 3.09 mg/d, which was enough to meet the physiological requirement for 57 % of the adolescent girls. Therefore, the low Zn intake and the Zn status of adolescent girls were positively impacted by Zn-fortified milk intake and its good absorption rate.

Bioavailability of iron, vitamin A, zinc, and folic acid when added to condiments and seasonings

Seasonings and condiments can be candidate vehicles for micronutrient fortification if consumed consistently and if dietary practices ensure bioavailability of the nutrient. In this review, we identify factors that may affect the bioavailability of iron, vitamin A, zinc, and folic acid when added to seasonings and condiments and evaluate their effects on micronutrient status. We take into consideration the chemical and physical properties of different forms of the micronutrients, the influence of the physical and chemical properties of foods and meals to which fortified seasonings and condiments are typically added, and interactions between micronutrients and the physiological and nutritional status of the target population. Bioavailable fortificants of iron have been developed for use in dry or fluid vehicles. For example, sodium iron ethylenediaminetetraacetic acid (NaFeEDTA) and ferrous sulfate with citric acid are options for iron fortification of fish and soy sauce. Furthermore, NaFeEDTA, microencapsulated ferrous fumarate, and micronized elemental iron are potential fortificants in curry powder and salt. Dry forms of retinyl acetate or palmitate are bioavailable fortificants of vitamin A in dry candidate vehicles, but there are no published studies of these fortificants in fluid vehicles. Studies of zinc and folic acid bioavailability in seasonings and condiments are also lacking.

The potential for zinc stable isotope techniques and modelling to determine optimal zinc supplementation

It is well recognised that zinc deficiency is a major global public health issue, particularly in young children in low-income countries with diarrhoea and environmental enteropathy. Zinc supplementation is regarded as a powerful tool to correct zinc deficiency as well as to treat a variety of physiologic and pathologic conditions. However, the dose and frequency of its use as well as the choice of zinc salt are not clearly defined regardless of whether it is used to treat a disease or correct a nutritional deficiency. We discuss the application of zinc stable isotope tracer techniques to assess zinc physiology, metabolism and homeostasis and how these can address knowledge gaps in zinc supplementation pharmacokinetics. This may help to resolve optimal dose, frequency, length of administration, timing of delivery to food intake and choice of zinc compound. It appears that long-term preventive supplementation can be administered much less frequently than daily but more research needs to be undertaken to better understand how best to intervene with zinc in children at risk of zinc deficiency. Stable isotope techniques, linked with saturation response and compartmental modelling, also have the potential to assist in the continued search for simple markers of zinc status in health, malnutrition and disease.

Influence of phytase, EDTA, and polyphenols on zinc absorption in adults from porridges fortified with zinc sulfate or zinc oxide

Fortification of cereal staples with zinc is recommended to combat zinc deficiency. To optimize zinc absorption, strategies are needed to overcome the inhibitory effect of phytic acid (PA) and perhaps polyphenols. Five zinc absorption studies were conducted in young adults consuming maize or sorghum porridges fortified with 2 mg zinc as zinc sulfate (ZnSO4) or zinc oxide (ZnO) and containing combinations of PA or polyphenols as potential inhibitors and EDTA and phytase as potential enhancers. Fractional absorption of zinc (FAZ) was measured by using the double isotopic tracer ratio method. Adding phytase to the maize porridge immediately before consumption or using phytase for dephytinization during meal preparation both increased FAZ by >80% (both P < 0.001). Adding Na2EDTA at an EDTA:zinc molar ratio of 1:1 increased FAZ from maize porridge fortified with ZnSO4 by 30% (P = 0.01) but had no influence at higher EDTA ratios or on absorption from ZnO. FAZ was slightly higher from ZnSO4 than from ZnO (P = 0.02). Sorghum polyphenols had no effect on FAZ from dephytinized sorghum porridges but decreased FAZ by 20% from PA-rich sorghum porridges (P < 0.02). The combined inhibitory effect of polyphenols and PA was overcome by EDTA. In conclusion, ZnSO4 was better absorbed than ZnO, phytase used to degrade PA during digestion or during food preparation substantially increased zinc absorption from zinc-fortified cereals, EDTA at a 1:1 molar ratio modestly enhanced zinc absorption from ZnSO4-fortified cereals but not ZnO-fortified cereals, and sorghum polyphenols inhibited zinc absorption in the presence, but not absence, of PA. This trial was registered at clinicaltrials.gov as NCT01210794.

Zinc absorption by young adults from supplemental zinc citrate is comparable with that from zinc gluconate and higher than from zinc oxide

The water-soluble zinc salts gluconate, sulfate, and acetate are commonly used as supplements in tablet or syrup form to prevent zinc deficiency and to treat diarrhea in children in combination with oral rehydration. Zinc citrate is an alternative compound with high zinc content, slightly soluble in water, which has better sensory properties in syrups but no absorption data in humans. We used the double-isotope tracer method with (67)Zn and (70)Zn to measure zinc absorption from zinc citrate given as supplements containing 10 mg of zinc to 15 healthy adults without food and compared absorption with that from zinc gluconate and zinc oxide (insoluble in water) using a randomized, double-masked, 3-way crossover design. Median (IQR) fractional absorption of zinc from zinc citrate was 61.3% (56.6-71.0) and was not different from that from zinc gluconate with 60.9% (50.6-71.7). Absorption from zinc oxide at 49.9% (40.9-57.7) was significantly lower than from both other supplements (P < 0.01). Three participants had little or no absorption from zinc oxide. We conclude that zinc citrate, given as a supplement without food, is as well absorbed by healthy adults as zinc gluconate and may thus be a useful alternative for preventing zinc deficiency and treating diarrhea. The more insoluble zinc oxide is less well absorbed when given as a supplement without food and may be minimally absorbed by some individuals. This trial was registered at clinicaltrials.gov as NCT01576627.

HvZIP7 mediates zinc accumulation in barley (Hordeum vulgare) at moderately high zinc supply

High expression of zinc (Zn)-regulated, iron-regulated transporter-like protein (ZIP) genes increases root Zn uptake in dicots, leading to high accumulation of Zn in shoots. However, none of the ZIP genes tested previously in monocots could enhance shoot Zn accumulation. In this report, barley (Hordeum vulgare) HvZIP7 was investigated for its functions in Zn transport. The functions of HvZIP7 in planta were studied using in situ hybridization and transient analysis of subcellular localization with a green fluorescent protein (GFP) reporter. Transgenic barley lines overexpressing HvZIP7 were also generated to further understand the functions of HvZIP7 in metal transport. HvZIP7 is strongly induced by Zn deficiency, primarily in vascular tissues of roots and leaves, and its protein was localized in the plasma membrane. These properties are similar to its closely related homologs in dicots. Overexpression of HvZIP7 in barley plants increased Zn uptake when moderately high concentrations of Zn were supplied. Significantly, there was a specific enhancement of shoot Zn accumulation, with no measurable increase in iron (Fe), manganese (Mn), copper (Cu) or cadmium (Cd). HvZIP7 displays characteristics of low-affinity Zn transport. The unique function of HvZIP7 provides new insights into the role of ZIP genes in Zn homeostasis in monocots, and offers opportunities to develop Zn biofortification strategies in cereals.

Bioavailability of iron, zinc, folic acid, and vitamin A from fortified maize

Several strategies appear suitable to improve iron and zinc bioavailability from fortified maize, and fortification per se will increase the intake of bioavailable iron and zinc. Corn masa flour or whole maize should be fortified with sodium iron ethylenediaminetetraacetate (NaFeEDTA), ferrous fumarate, or ferrous sulfate, and degermed corn flour should be fortified with ferrous sulfate or ferrous fumarate. The choice of zinc fortificant appears to have a limited impact on zinc bioavailability. Phytic acid is a major inhibitor of both iron and zinc absorption. Degermination at the mill will reduce phytic acid content, and degermed maize appears to be a suitable vehicle for iron and zinc fortification. Enzymatic phytate degradation may be a suitable home-based technique to enhance the bioavailability of iron and zinc from fortified maize. Bioavailability experiments with low phytic acid-containing maize varieties have suggested an improved zinc bioavailability compared to wild-type counterparts. The bioavailability of folic acid from maize porridge was reported to be slightly higher than from baked wheat bread. The bioavailability of vitamin A provided as encapsulated retinyl esters is generally high and is typically not strongly influenced by the food matrix, but has not been fully investigated in maize.

Bioavailability of zinc oxide added to corn tortilla is similar to that of zinc sulfate and is not affected by simultaneous addition of iron

BACKGROUND

Corn tortilla is the staple food of Mexico and its fortification with zinc, iron, and other micronutrients is intended to reduce micronutrient deficiencies. However, no studies have been performed to determine the relative amount of zinc absorbed from the fortified product and whether zinc absorption is affected by the simultaneous addition of iron.

OBJECTIVE

To compare zinc absorption from corn tortilla fortified with zinc oxide versus zinc sulfate and to determine the effect of simultaneous addition of two doses of iron on zinc bioavailability.

METHODS

A randomized, double-blind, crossover design was carried out in two phases. In the first phase, 10 adult women received corn tortillas with either 20 mg/kg of zinc oxide added, 20 mg/kg of zinc sulfate added, or no zinc added. In the second phase, 10 adult women received corn tortilla with 20 mg/kg of zinc oxide added and either with no iron added or with iron added at one of two different levels. Zinc absorption was measured by the stable isotope method.

RESULTS

The mean (+/- SEM) fractional zinc absorption from unfortified tortilla, tortilla fortified with zinc oxide, and tortilla fortified with zinc sulfate did not differ among treatments: 0.35 +/- 0.07, 0.36 +/- 0.05, and 0.37 +/- 0.07, respectively. The three treatment groups with 0, 30, and 60 mg/kg of added iron had similar fractional zinc absorption (0.32 +/- 0.04, 0.33 +/- 0.02, and 0.32 +/- 0.05, respectively) and similar amounts of zinc absorbed (4.8 +/- 0.7, 4.5 +/- 0.3, and 4.8 +/- 0.7 mg/day, respectively).

CONCLUSIONS

Since zinc oxide is more stable and less expensive and was absorbed equally as well as zinc sulfate, we suggest its use for corn tortilla fortification. Simultaneous addition of zinc and iron to corn tortilla does not modify zinc bioavailability at iron doses of 30 and 60 mg/kg of corn flour.

Effect of zinc sulfate fortificant on iron absorption from low extraction wheat flour co-fortified with ferrous sulfate

The co-fortification of wheat flour with iron (Fe) and zinc (Zn) is a strategy used to prevent these deficiencies in the population. Given that Zn could interact negatively with Fe, the objective was to assess the effect of Zn on Fe absorption from bread prepared with wheat flour fortified with Fe and graded levels of Zn fortificant. Twelve women aged 30-43 years, with contraception and a negative pregnancy test, participated in the study. They received on four different days, after an overnight fast, 100 g of bread made with wheat flour (70 % extraction) fortified with 30 mg Fe/kg as ferrous sulfate (A) or prepared with the same Fe-fortified flour but with graded levels of Zn, as zinc sulfate: 30 mg/kg (B), 60 mg/kg (C), or 90 mg/kg (D). Fe radioisotopes ((59)Fe and (55)Fe) of high specific activity were used as tracers and Fe absorption iron was measured by the incorporation of radioactive Fe into erythrocytes.

RESULTS

The geometric mean and range of ± 1 SD of Fe absorption were: A= 19.8 % (10.5-37.2 %), B = 18.5 % (10.2-33.4 %), C = 17.7 % (7.7-38.7 %), and D = 11.2 % (6.2-20.3 %), respectively; ANOVA for repeated measures F = 5.14, p < 0.01 (Scheffè's post hoc test: A vs D and B vs D, p < 0.05). We can conclude that Fe is well absorbed from low extraction flour fortified with 30 mg/kg of Fe, as ferrous sulfate, and up to 60 mg/kg of Zn, as Zn sulfate. A statistically significant reduction of Fe absorption was observed at a Zn fortification level of 90 mg Zn/kg.

EDTA disodium zinc has superior bioavailability compared to common inorganic or chelated zinc compounds in rats fed a high phytic acid diet

Different zinc (Zn) compounds have unique properties that may influence the amount of Zn absorbed particularly in the presence of phytic acid (PA), a common food component that binds Zn and decreases its bioavailability. In this study, 30-day-old male rats (n=12/diet group) were fed diets supplemented with PA (0.8%) and low levels (8mg Zn/kg diet) of inorganic (Zn oxide, Zn sulphate) or chelated (Zn gluconate, Zn acetate, Zn citrate, EDTA disodium Zn, Zn orotate) Zn compounds for 5 weeks. Two control groups were fed diets supplemented with low or normal (30mg Zn/kg diet) Zn (as Zn oxide) without added PA. Control rats fed the low Zn oxide diet showed depressed Zn status. Addition of PA to this diet exacerbated the Zn deficiency in rats. Growth (body weight gain and femur length) and Zn concentrations in plasma and tissues were similar in rats fed Zn oxide, Zn sulphate, Zn gluconate, Zn acetate, Zn citrate or Zn orotate. Rats fed EDTA disodium Zn showed enhanced growth compared to rats fed Zn oxide or Zn gluconate and had higher Zn concentrations in plasma and femur compared to rats fed all other Zn compounds. Only the haematological profile of rats fed EDTA disodium Zn did not differ from control rats fed normal Zn. These data indicate that in rats fed a high PA diet, bioavailability of commonly used inorganic or chelated Zn compounds does not differ appreciably, but Zn supplied as an EDTA disodium salt has superior bioavailability.

Plasma zinc concentration responds to short-term zinc supplementation, but not zinc fortification, in young children in Senegal1,2

BACKGROUND

Simple, low-cost methods are needed to evaluate the effect of zinc-fortification programs. Plasma zinc concentration is a useful biomarker of zinc intake from supplementation, but responses to zinc fortification are inconsistent.

OBJECTIVE

The objective was to compare the change in plasma zinc concentrations in young children who received zinc from either a liquid supplement or a zinc-fortified complementary food.

DESIGN

A double-blind intervention trial was conducted in 137 young Senegalese children aged 9-17 mo who were randomly assigned to receive one of the following treatments for 15 d: 1) 30 g dry weight of an iron-fortified cereal porridge and a liquid multivitamin supplement without zinc (control group), 2) the same porridge and multivitamin supplement with 6 mg Zn added to the supplement dose (ZnSuppl group), or 3) the same porridge with added zinc to provide 6 mg Zn per 25 g dry weight of porridge and multivitamin without zinc (ZnFort group).

RESULTS

Mean (±SD) plasma zinc concentration (μg/dL) increased by 4.7 ± 1.6 (P = 0.004) in the ZnSuppl group, which was significantly greater (P = 0.009) than the mean change in the control group (-1.0 ± 1.6; P = 0.51) and in the ZnFort group (-1.8 ± 1.7; P = 0.29). The latter 2 groups did not differ from each other (P = 0.99).

CONCLUSIONS

Plasma zinc concentration increased in children who received daily zinc supplementation for 15 d but not in those who received a zinc-fortified complementary food containing a similar amount of zinc. Additional longer-term studies are needed to assess the effect of zinc-fortification programs on zinc-related functional outcomes and the usefulness of plasma zinc as a biomarker of program effect. This trial was registered at www.clinicaltrials.gov as study NCT0094398.

Fortification of sorghum (Sorghum vulgare) and pearl millet (Pennisetum glaucum) flour with zinc

Deficiency of zinc is believed to be as widespread as that of iron, with equally serious consequences. Fortification of staple foods with this mineral is a cost-effective method that can be used to combat this deficiency. In the present study, flours of pearl millet and sorghum were evaluated as vehicles for fortification with zinc. Zinc stearate was used as the fortificant, and added at a level that provided 5mg Zn/100g flour. The metal chelator EDTA was used as a co-fortificant, the molar ratio of exogenous Zn:EDTA being 1:1. Bioaccessibility of zinc from the fortified flours, both raw and cooked, was determined by an in vitro simulated gastrointestinal digestion procedure. The results of the study revealed that there were differences among these two flours with respect to the feasibility of fortification with zinc. Although fortified pearl millet flour provided a higher amount of bioaccessible zinc, this was attributable to the presence of EDTA, rather than to the fortified zinc. The benefit of fortification with zinc was more evident in sorghum flour, compared to that in pearl millet flour, the increase in bioaccessible zinc content being more than 1.5 times higher as a result of fortification. Fortified sorghum and pearl millet flours were stable during storage for a period of up to 60 days. Thus, millet flours seem to be satisfactory candidates for fortification with zinc, and can be exploited to address zinc deficiency.

Zinc fortification of cereal flours: current recommendations and research needs

BACKGROUND

Zinc fortification is recommended as an appropriate strategy to enhance population zinc status, but guidelines are needed on the appropriate types and levels of zinc fortification of cereal flours for mass fortification programs.

OBJECTIVE

To review available information on the scientific rationale, efficacy, and effectiveness of zinc fortification programs, and to develop guidelines on appropriate levels of fortification of cereal flours, based on simulations of the amount of zinc absorbed under different dietary conditions and information on possible adverse effects.

METHODS

Systematic review of scientific literature and application of an existing prediction equation to estimate zinc absorption.

RESULTS

Previously completed research demonstrates that zinc intake and absorption are increased when zinc-fortified foods are consumed, but little information is, as yet, available on the biologic impact of large-scale fortification programs. Studies suggest that there are no disadvantages of the recommended ranges of zinc fortification with regard to the sensory properties of zinc-fortified foods, and most research indicates that there are no adverse effects of zinc fortification on the utilization of other minerals.

CONCLUSIONS

Zinc fortification of cereal flour is a safe and appropriate strategy for enhancing the zinc status of population subgroups who consume adequate amounts of fortified cereal flour, although additional information is needed to confirm the efficacy and effectiveness of large-scale zinc fortification programs to control zinc deficiency. The appropriate level of fortification depends on the population subgroup, their usual amount of flour intake, the degree of milling and fermentation that is practiced, and the usual intakes of zinc and phytate from other food sources. Fortification recommendations are presented for different dietary scenarios.

Zinc bioavailability and homeostasis

Zinc has earned recognition recently as a micronutrient of outstanding and diverse biological, clinical, and global public health importance. Regulation of absorption by zinc transporters in the enterocyte, together with saturation kinetics of the absorption process into and across the enterocyte, are the principal means by which whole-body zinc homeostasis is maintained. Several physiologic factors, most notably the quantity of zinc ingested, determine the quantity of zinc absorbed and the efficiency of absorption. Other factors are age and the time over which zinc is ingested. Zinc from supplements has not been shown to be absorbed differently from that taken with meals that lack inhibitors of zinc absorption. The principal dietary factor known to impair zinc bioavailability is inositol hexa- (and penta-) phosphate or phytate. Modeling of zinc absorption as a function of dietary zinc and phytate accounts for >80% of the variability in the quantity of zinc absorbed. Fitting the model to new data has resulted in continual improvement in parameter estimates, which currently indicate a maximal absorption in adults of approximately 6 mg Zn/d and that the average estimated dietary requirement doubles with 1000 mg dietary phytate/d. Intestinal excretion of endogenous zinc is regulated in response to recent absorption and to zinc status. The quantitative relation of intestinal excretion of endogenous zinc to zinc absorption is currently considered to be of major importance in the determination of zinc requirements. The effects of phytate on intestinal losses of endogenous zinc merit further investigation but are probably not of the same magnitude as its inhibitory effects on absorption of exogenous zinc.

Impact of Zinc Fortification on Zinc Nutrition

Food fortification is increasingly recognized as an effective approach to improve a population's micronutrient status. The present report provides a critical review of the scientific evidence currently available on the impact of zinc fortification on zinc nutrition.

The available studies clearly show that zinc fortification can increase dietary zinc intake and total daily zinc absorption. Most absorption studies also indicate that adding zinc to food does not adversely affect the absorption of other minerals, such as iron. Despite the positive effect of zinc fortification on total zinc absorption, only a few studies have found positive impacts of zinc fortification on serum zinc concentrations or functional indicators of zinc status. The reasons for these inconsistent results are uncertain but may relate to the choice of food vehicles, the age group and zinc status of the study populations, or particular aspects of the study design. Thus, additional research is needed to determine the impact of zinc fortification, with or without other micronutrients, in populations at risk for zinc deficiency.

Because of the benefits of increasing intake in populations at high risk for zinc deficiency, the documented increase in total zinc absorption that occurs following zinc fortification, the absence of any adverse effects, and the relatively low cost of adding zinc, public health planners should consider including zinc in mass and targeted fortification programs in such populations. Because of the limited available information on program impact, it will be important to evaluate the outcomes of such programs.

Dialyzability of Minerals in Corn Masa Gruel (Atole) Fortified with Different Iron Compounds: Effects of Ascorbic Acid, Disodium EDTA, and Phytic Acid

Background

Lime-treated corn gruel ( atole) is a common weaning food in iron-deficient populations, especially in Mexico and Central America, and is a potential vehicle for fortification with iron.

Objective

The objective of this study was to screen promising iron compounds for use in the fortification of atole, using in vitro enzymatic digestion–dialysis techniques, while also considering their response to known iron absorption enhancers and inhibitors.

Methods

Atole, unaltered or preincubated with phytase, was fortified with iron (10 mg/L) from ferrous sulfate, ferrous bisglycinate, or ferrous fumarate, or with ferric chloride, ferric ammonium citrate, or ferric sodium ethylenediaminetetraacetic acid (NaFeEDTA), and submitted to in vitro digestion. Dialysis of calcium, copper, iron, phosphorus, and zinc (analyzed by inductively coupled plasma atomic emission spectrometry) was measured when atole was fortified with iron compounds alone or together with ascorbic acid or disodium ethyl- enediaminetetraacetic acid (Na2 EDTA).

Results

Iron dialyzability was higher with NaFeEDTA ( p < .05) than with all other iron compounds, which did not differ among themselves in iron dialyzability. Addition of ascorbic acid had no significant effect on iron dialysis, whereas Na2 EDTA enhanced iron dialyzability by 7 to 10 times in unaltered atole and 15 to 20 times in phytase-preincubated atole ( p < .05). Addition of Na2 EDTA always increased intrinsic zinc dialyzability, and most of the time this increase was significant. Phytase pretreatment generally increased mineral dialysis.

Conclusions

Adding EDTA (either as NaFeEDTA or as Na2 EDTA) to atole can increase the dialyzability of ferrous and ferric iron compounds and enhance the dialyzability of intrinsic zinc without any negative effects on calcium, phosphorus, or copper dialysis.

Zinc: the missing link in combating micronutrient malnutrition in developing countries

The first cases of human Zn deficiency were described in the 1960s in the Middle East. Nevertheless, it was not until 2002 that Zn deficiency was included as a major risk factor in the global burden of disease, and only in 2004 did WHO/UNICEF include Zn supplements in the treatment of acute diarrhoea. Despite this recognition Zn is still not included in the UN micronutrient priority list, an omission that will continue to hinder efforts to reduce child and maternal mortality, combat HIV/AIDS, malaria and other diseases and achieve the UN Millennium Development Goals for improved nutrition in developing countries. Reasons for this omission include a lack of awareness of the importance of Zn in human nutrition, paucity of Zn and phytate food composition values and difficulties in identifying Zn deficiency. Major factors associated with the aetiology of Zn deficiency include dietary inadequacies, disease states inducing excessive losses or impairing utilization and physiological states increasing Zn requirements. To categorize countries according to likely risk of Zn deficiency the International Zinc Nutrition Consultative Group has developed indirect indicators based on the adequacy of Zn in the national food supplies and/or prevalence of childhood growth stunting. For countries identified as at risk confirmation is required through direct measurements of dietary Zn intake and/or serum Zn in a representative sample. Finally, in at risk countries either national or targeted Zn interventions such as supplementation, fortification, dietary diversification or modification, or biofortification should be implemented, where appropriate, by incorporating them into pre-existing micronutrient intervention programmes.