Role of zinc supplementation in school aged children suffering from common cold: A clinical trial

 

V K Tandon¹, Gaurav Arya^2*

 

Abstract               Background: In developing countries Zinc deficiency is very common among school aged children because of less animal food in diet, and more dietary phytate content. Zinc deficiency causes decreased overall immunity and increases chances of infection. So more studies are needed to see effect of zinc supplement in common cold in children’s as it is still questionable. To determine role of supplementation could reduce frequency rate and duration of Common cold during cold season in school aged children living in a low socioeconomic areas of Lakhanpur, Kanpur. Methods: We designed a randomized double‐blind, placebo‐controlled efficacy trial. Subjects were 200 grade 2 primary school children who all completed the trial. Intervention supplementation was zinc sulfate tablets (10 mg elemental) and placebo tablets for case and control groups, respectively. Tablets were taken on a daily basis, 6 days a week, for 5 months (November 2016 to March 2017). Findings: Among the zinc‐supplemented group common cold incidence of 1.37±0.86 episodes per child during the study period was recorded in comparison to 3.15±0.55 cold episodes per child among the placebo group (P<0.001). Mean overall missing days from school was 0.55±1.09 days and 1.35±1.79 days for zinc‐supplemented and placebo groups, respectively. The need for administration of antibiotics for bacterial infections (pharyngitis, acute otitis media, sinusitis, pneumonia) were 20 and 47 courses for zinc‐supplemented and placebo groups, respectively (P<0.01). Conclusion: This study showed that zinc supplementation has a beneficial impact on the occurrence of common cold

Key Words: Zinc Supplementation; common cold; upper respiratory Infection; children.

 

INTRODUCTION

Zinc is an essential micronutrient for human growth, development, and immune function. Mild to moderate zinc deficiency can be best detected through a positive response to supplementation trials. Zinc supplementation has been shown to have a positive effect on the incidence of diarrhea, and pneumonia¹. Upper respiratory tract viral infections are one of the most common reasons for physician visits. School aged children may experience 6 to 8 colds per year². In children, this illness is also more extensive than in adults and usually requires medical attention. Statistics indicate that more than 80% of common colds requiring medical attention affect children and adolescents³. Zinc salts have been found to inhibit rhinovirus replication in vitro, possibly by interfering with rhinovirus protein cleavage ⁴. It has also been suggested that cold symptoms, sneezing and nasal congestion, might be reduced by elevations in intranasal zinc salts, producing a chemical clamp, or may be due to correction of a subclinical zinc deficiency^{5, 6}. Several controlled trials of treatment of common cold with zinc have been published; however, there are only a few community‐based longitudinal studies that have been conducted with zinc supplementation for prevention of common cold during cold season⁷. To investigate the effect of zinc supplementation on the prevention of occurrence and the need for antibiotic administration, we performed an intervention trial among school aged children in lakhanpur, kanpur.

 

Subjects and Methods

The study was a randomized, double‐blind, placebo‐controlled, community‐based intervention trial conducted between November 2016 and March 2017 in a low socioeconomic areas of lakhanpur, Kanpur.The project was approved by the scientific advisory and ethical committees of Rama University of Medical Sciences Kanpur. Written informed consent forms were signed by the parents before including the children in the study. For ethical reasons and limitation of cost we did not measure plasma Zink levels in this study.  A total of 200 children (aged 78 to 120 months) were randomly assigned to daily (6 days in week) supplementation with 10 mg elemental zinc as a tablet (n=100, 50 males, and 50 females), or placebo (n=100, 50 males, and 50 females). For each child that was enrolled in the study, a standardized questionnaire was completed to obtain family details including basic demographic and socioepidemiologic data. The subjects were free of chronic diseases, such as sickle cell disease, or protein‐energy malnutrition. All participants were observed on a daily basis for any medical sign and symptom especially cold symptoms. This daily surveillance for the detection of any sign and symptom of common cold and other possible diseases was conducted by trained health workers. These workers were also responsible for proper administration of the zinc or placebo tablets. Regular field visits (once a week) for additional data collection and supervision of the health workers were made by our physician. Common cold was defined as the presence of at least two of the following symptoms: cough, headache, hoarseness, muscle ache, nasal drainage, nasal congestion, scratchy throat, sore throat, sneezing, and fever. Data were analyzed using statistical software packages SPSS ll.5 (SPSS, Inc, Chicago, IL) and Epi Info (Center for Disease Control and Prevention, Atlanta, GA) using the χ2 test ,t‐test and ANOVA, P values less than 0.05 was considered statistically significant.

P<0.001). In the zinc supplemented group, three participants complained from mild gastrointestinal discomfort which was resolved within few days and there was no need for their exclusion from the study.

DISCUSSION

Millions of people throughout the world may have inadequate levels of zinc in their diet due to limited access to zinc‐rich foods (animal products, oysters and shellfish) and the abundance of zinc inhibitors such as phytate, common in plant‐based diets ⁸. Zinc is a key component of the cell architecture and is required for the production of over 200 enzymes including phosphatase, metalloproteinases, oxidoreductase, and transferase which are involved in protein synthesis, nucleic acid metabolism, and immune function¹⁸. Zinc deficiency is common in young children in the developing countries and is associated with reduced immuno‐competence and increased rates of serious infectious diseases⁹. Several studies have shown that zinc supplementation has a positive influence on linear, motor development and weight gain¹⁹. Community‐based studies conducted among children of different age groups have shown thebeneficial impact of zinc supplementation in the form of reduced diarrhea episodes in children with zinc deficiency, since this supplementation may lead to accelerated regeneration of mucosa, increased levels of brush border enzymes, enhanced cellular immunity, and higher levels of secretory antibodies ¹⁰.

Policy for Articles with Open Access:

Authors who publish with MedPulse International Journal of Pediatrics (Print ISSN: 2579-0897) (Online ISSN: 2636-4662) agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.