Zinc and multivitamin supplementation have contrasting effects on infant iron status: a randomized, double-blind, placebo-controlled clinical trial

Zinc (Zn) supplementation adversely affects iron status in animal and adult human studies, but few trials have included young infants. The objective of this study was to determine the effects of Zn and multivitamin (MV) supplementation on infant hematologic and iron status. In a double-blind RCT, Ta...

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Bibliographic Details
Published in:European journal of clinical nutrition 2018-01, Vol.72 (1), p.130-135
Main Authors: Carter, R C, Kupka, R, Manji, K, McDonald, C M, Aboud, S, Erhardt, J G, Gosselin, K, Kisenge, R, Liu, E, Fawzi, W, Duggan, C P
Format: Article
Language:English
Subjects:
Anemia
Anemia, Iron-Deficiency - blood
Blood levels
Clinical trials
Confidence intervals
Dietary Supplements
Double-Blind Method
Double-blind studies
Erythrocytes
Ferritins - blood
Health aspects
Hemoglobin
Hemoglobins - analysis
Humans
Infant
Infant Nutritional Physiological Phenomena
Infants
Iron
Iron - blood
Iron - deficiency
Iron deficiency diseases
Nutrient deficiency
Nutritional Status - drug effects
Placebos
Randomization
Recommended Dietary Allowances
Reduction
Regression analysis
Regression models
Risk
Risk Factors
Statistical analysis
Tanzania
Vitamins
Vitamins - administration & dosage
Zinc
Zinc (Nutrient)
Zinc - administration & dosage
Zinc - adverse effects
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Summary:Zinc (Zn) supplementation adversely affects iron status in animal and adult human studies, but few trials have included young infants. The objective of this study was to determine the effects of Zn and multivitamin (MV) supplementation on infant hematologic and iron status. In a double-blind RCT, Tanzanian infants were randomized to daily, oral Zn, MV, Zn and MV or placebo treatment arms at the age of 6 weeks of life. Hemoglobin concentration (Hb) and red blood cell indices were measured at baseline and at 6, 12 and 18 months of age. Plasma samples from 589 infants were examined for iron deficiency (ID) at 6 months. In logistic regression models, Zn treatment was associated with greater odds of ID (odds ratio (OR) 1.8 (95% confidence interval (CI) 1.0-3.3)) and MV treatment was associated with lower odds (OR 0.49 (95% CI 0.3-0.9)). In Cox models, MV was associated with a 28% reduction in risk of severe anemia (hazard ratio (HR)=0.72 (95% CI 0.56-0.94)) and a 26% reduction in the risk of severe microcytic anemia (HR=0.74 (0.56-0.96)) through 18 months. No effects of Zn on risk of anemia were seen. Infants treated with MV alone had higher mean Hb (9.9 g/dl (95% CI 9.7-10.1)) than those given placebo (9.6 g/dl (9.4-9.8)) or Zn alone (9.6 g/dl (9.4-9.7)). MV treatment improved iron status in infancy, whereas Zn worsened iron status but without an associated increase in risk for anemia. Infants in long-term Zn supplementation programs at risk for ID may benefit from screening and/or the addition of a MV supplement.
ISSN:0954-3007
1476-5640
DOI:10.1038/ejcn.2017.138