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Wessells KR, Hinnouho GM, Barffour MA, Arnold CD, Kounnavong S, Kewcharoenwong C, Lertmemongkolchai G, Schuster GU, Stephensen CB, Hess SY. Impact of Daily Preventive Zinc or Therapeutic Zinc Supplementation for Diarrhea on Plasma Biomarkers of Environmental Enteric Dysfunction among Rural Laotian Children: A Randomized Controlled Trial. Am J Trop Med Hyg 2020; 102:415-426. [PMID: 31889508 PMCID: PMC7008314 DOI: 10.4269/ajtmh.19-0584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/11/2019] [Indexed: 12/18/2022] Open
Abstract
Environmental enteric dysfunction (EED) may be ameliorated by zinc supplementation. The objective of this study was to investigate the impact of different forms of zinc supplementation on biomarkers of EED (i.e., plasma citrulline, kynurenine, and tryptophan concentrations and the kynurenine:tryptophan [KT] ratio) among young Laotian children. In a double-blind randomized controlled trial, 3,407 children aged 6-23 months were randomized into one of four groups: daily preventive zinc dispersible tablets (PZ; 7 mg zinc), daily multiple micronutrient powders (MNP; 10 mg zinc, 6 mg iron, and 13 other micronutrients), therapeutic zinc supplements for diarrhea treatment (TZ; 20 mg/day for 10 days), or daily placebo powder, and followed up for ∼36 weeks. Plasma samples at baseline and endline for 359 children were analyzed for citrulline, kynurenine, and tryptophan concentrations. At baseline, the prevalence of stunting and zinc deficiency was 37% and 76.5%, respectively. The mean plasma citrulline, kynurenine, and tryptophan concentrations were 24.6 ± 5.4 µmol/L, 3.27 ± 0.83 µmol/L, and 72.3 ± 12.9 µmol/L, respectively; the mean KT ratio (×1,000) was 45.9 ± 12.0. At endline, neither plasma citrulline, kynurenine, or tryptophan concentrations, nor the KT ratio differed among intervention groups (P > 0.05). In this population, PZ, MNP, and TZ had no overall effect on plasma concentrations of citrulline, kynurenine, and tryptophan, or the KT ratio. The need remains to better understand the etiology of EED, and the development of biomarkers to diagnose EED and evaluate the impact of interventions.
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Affiliation(s)
- K. Ryan Wessells
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
| | - Guy-Marino Hinnouho
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
| | - Maxwell A. Barffour
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
- Public Health Program, College of Health and Human Services, Missouri State University, Springfield, Missouri
| | - Charles D. Arnold
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | - Chidchamai Kewcharoenwong
- Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Associated Medical Sciences, The Centre for Research and Development of Medical Diagnostic Laboratories, Khon Kaen University, Khon Kaen, Thailand
| | - Ganjana Lertmemongkolchai
- Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Associated Medical Sciences, The Centre for Research and Development of Medical Diagnostic Laboratories, Khon Kaen University, Khon Kaen, Thailand
| | - Gertrud U. Schuster
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
- Agricultural Research Service, Western Human Nutrition Research Center, US Department of Agriculture, Davis, California
| | - Charles B. Stephensen
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
- Agricultural Research Service, Western Human Nutrition Research Center, US Department of Agriculture, Davis, California
| | - Sonja Y. Hess
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
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