What zinc supplementation does and does not achieve in diarrhea prevention: a systematic review and meta-analysis

BMC Infectious Diseases

Research Article

Neetu Badhoniya¹  Archana B Patel²  Hemant Kulkarni³  Manju Mamtani³ 

[1] Lata Medical Research Foundation, Nagpur, India;Lata Medical Research Foundation, Nagpur, India;Indira Gandhi Government Medical College, Nagpur, India;Lata Medical Research Foundation, Nagpur, India;The University of Texas Health Science Center at San Antonio, Texas, USA;

关键词: Prediction Interval;    Zinc Supplementation;    Dysentery;    Persistent Diarrhea;    Childhood Diarrhea;   

DOI  :  10.1186/1471-2334-11-122

 received in 2011-01-25, accepted in 2011-05-12,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundPrevention of diarrhea has presented indomitable challenges. A preventive strategy that has received significant interest is zinc supplementation. Existing literature including quantitative meta-analyses and systematic reviews tend to show that zinc supplementation is beneficial however evidence to the contrary is augmenting. We therefore conducted an updated and comprehensive meta-analytical synthesis of the existing literature on the effect of zinc supplementation in prevention of diarrhea.MethodsEMBASE®, MEDLINE ® and CINAHL® databases were searched for published reviews and meta-analyses on the use of zinc supplementation for the prevention childhood diarrhea. Additional RCTs published following the meta-analyses were also sought. Effect of zinc supplementation on the following five outcomes was studied: incidence of diarrhea, prevalence of diarrhea, incidence of persistent diarrhea, incidence of dysentery and incidence of mortality. The published RCTs were combined using random-effects meta-analyses, subgroup meta-analyses, meta-regression, cumulative meta-analyses and restricted meta-analyses to quantify and characterize the role of zinc supplementation with the afore stated outcomes.ResultsWe found that zinc supplementation has a modest beneficial association (9% reduction) with incidence of diarrhea, a stronger beneficial association (19% reduction) with prevalence of diarrhea and occurrence of multiple diarrheal episodes (28% reduction) but there was significant unexplained heterogeneity across the studies for these associations. Age, continent of study origin, zinc salt and risk of bias contributed significantly to between studies heterogeneity. Zinc supplementation did not show statistically significant benefit in reducing the incidence of persistent diarrhea, dysentery or mortality. In most instances, the 95% prediction intervals for summary relative risk estimates straddled unity.ConclusionsDemonstrable benefit of preventive zinc supplementation was observed against two of the five diarrhea-related outcomes but the prediction intervals straddled unity. Thus the evidence for a preventive benefit of zinc against diarrhea is inconclusive. Continued efforts are needed to better understand the sources of heterogeneity. The outcomes of zinc supplementation may be improved by identifying subgroups that need zinc supplementation.

【 授权许可】

Unknown   
© Patel et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.