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Zinc and vitamin A for prevention of upper respiratory tract infection in children

Published online by Cambridge University Press:  20 August 2012

Rashmi Ranjan Das*
Affiliation:
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi110029, India, email [email protected]
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Abstract

Type
Letter to the Editor
Copyright
Copyright © The Author 2012

I read with great interest the article by Kartasurya et al. (Reference Kartasurya, Ahmed and Subagio1). The authors conclude that Zn combined with vitamin A significantly reduces the percentage of days with upper respiratory tract infections (URTI) in preschool Indonesian children. However, there are a few points in the paper that deserve comment. First, the claimed reduction in the percentage of days with URTI following Zn supplementation (relative risk (RR) 0·88 (95 % CI 0·75, 1·02); P = 0·09) was not actually significant using the conventional threshold of P < 0·05. Similarly, the claimed significant interactive effect of Zn and vitamin A on URTI episodes (RR 0·94 (95 % CI 0·88, 1·01); P = 0·073) was also not significant. Second, the authors claim that a longer supplementation period would have enhanced the ability to examine both the overall and subgroup effects. However, because baseline Zn status was adequate, and not low, in both groups, it is unlikely that a longer period of supplementation would have benefited the population. The situation might be different if more malnourished and Zn-deficient children were included in the study(Reference Fischer Walker, Ezzati and Black2). Indeed, one trial that included children with moderate malnutrition and having a low baseline serum Zn level (post-trial Zn level being normal in the intervention group) found an 8 % reduction in URTI (P = 0·001) and 42 % reduction in suppurative otitis media (P = 0·002) in the Zn group, and the effect increased with increased severity of the disease(Reference Brooks, Santosham and Naheed3). Third, the statement by the authors that the smaller effect size for the reduction of URTI in the trial of Kartasurya et al. (Reference Kartasurya, Ahmed and Subagio1) compared to that seen in trials investigating lower respiratory tract infection (pneumonia) is due to variation in aetiology is highly speculative, and no trial of Zn has investigated respiratory infections of different aetiology(Reference Das4). In a recent meta-analysis, we found that Zn supplementation for at least 5 months reduces cold incidence, school absenteeism and prescription of antibiotics in children(Reference Singh and Das5).

References

1Kartasurya, MI, Ahmed, F, Subagio, HW, et al. (2012) Zinc combined with vitamin A reduces upper respiratory tract infection morbidity in a randomised trial in preschool children in Indonesia. Br J Nutr (epublication ahead of print version 14 March 2012).CrossRefGoogle Scholar
2Fischer Walker, CL, Ezzati, M & Black, RE (2009) Global and regional child mortality and burden of disease attributable to zinc deficiency. Eur J Clin Nutr 63, 591597.Google Scholar
3Brooks, WA, Santosham, M, Naheed, A, et al. (2005) Effect of weekly zinc supplements on incidence of pneumonia and diarrhoea in children younger than 2 years in an urban, low-income population in Bangladesh: randomised controlled trial. Lancet 366, 9991004.Google Scholar
4Das, RR (2011) Differential effects of zinc in severe pneumonia in children. Indian J Pediatr 78, 11591160.CrossRefGoogle ScholarPubMed
5Singh, M & Das, RR (2011) Zinc for the common cold. The Cochrane Database of Systematic Reviews, issue 2, CD001364.Google ScholarPubMed