title: Zinc supplementation in infants born small for gestational age reduces mortality: a prospective, randomized, controlled trial. Zinc supplementation, mental development and behaviour in low birth weight term infants in northeast Brazil Adding zinc to prenatal iron and folate supplements improves maternal and neonatal zinc status in a Peruvian population. Zinc supplementation and psychosocial stimulation: effects on the development of undernourished Jamaican children. Iron and zinc supplementation promote motor development and exploratory behavior among Bangladeshi infants. Zinc supplementation affects the activity patterns of rural Guatemalan infants. Zinc supplementation does not affect growth, morbidity, or motor development of US term breastfed infants at 4-10 mo of age. Growth and body composition of periurban Guatemalan children in relation to zinc status: a longitudinal zinc intervention trial. Combined iron and folic acid supplementation with or without zinc reduces time to walking unassisted among Zanzibari infants 5- to 11-mo old. Iron and zinc supplementation improved iron and zinc status, but not physical growth, of apparently healthy, breast-fed infants in rural communities of northeast Thailand. A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: effects on growth and development. Randomized controlled trial of the effect of zinc supplementation on the mental development of Bangladeshi infants. Randomized trial of the effect of zinc supplementation on the mental health of school-age children in Guatemala. Zinc Supplementation Improved Cognitive Performance and Taste Acuity in Indian Adolescent Girls Effects of repletion with zinc and other micronutrients on neuropsychologic performance and growth of Chinese children. Dietary boron, brain function, and cognitive performance. Effect of zinc supplementation on development and growth of Chilean infants. Daily supplementation with iron plus folic acid, zinc, and their combination is not associated with younger age at first walking unassisted in malnourished preschool children from a deficient population in rural Nepal. Zinc supplementation in very-low-birth-weight infants. Efficacy of Iron and/or Zinc Supplementation on Cognitive Performance of Lead-Exposed Mexican Schoolchildren: A Randomized, Placebo-Controlled Trial Iron and zinc supplementation does not improve parent or teacher ratings of behavior in first grade Mexican children exposed to lead. Effect of zinc supplementation on observed activity in low socioeconomic Indian preschool children. A preliminary report: effects of zinc and micronutrient repletion on growth and neuropsychological function of urban Chinese children. Impact of zinc supplementation on mental and psychomotor scores of children aged 12 to 18 months: a randomized, double-blind trial. Cognitive and motor development among small-for-gestational-age infants: impact of zinc supplementation, birth weight, and caregiving practices. Adding zinc to prenatal iron and folate tablets improves fetal neurobehavioral development. Effect of zinc supplementation on mood states in young women: a pilot study Long-term effects of iron and zinc supplementation during infancy on cognitive function at 9 y of age in northeast Thai children: a follow-up study. Zinc deficiency in anorexia nervosa. A growth-limiting, mild zinc-deficiency syndrome in some southern Ontario boys with low height percentiles. The Effects of Iron and/or Zinc Supplementation on Maternal Reports of Sleep in Infants from Nepal and Zanzibar
abstract: BACKGROUND Low birth weight infants have been noted to have low zinc concentrations in cord blood , and zinc deficiency in childhood is associated with reduced immunocompetence and increased infectious disease morbidity . This study investigates whether zinc supplementation of infants born full term and small for gestational age affects mortality . METHODS A r and omized , double-blind , controlled trial with 2-by-2 factorial design enrolled 1154 full-term small for gestational age infants to receive in syrup 1 of the following : riboflavin ; riboflavin and zinc ( 5 mg as sulfate ) ; riboflavin , calcium , phosphorus , folate , and iron ; or riboflavin , zinc , calcium , phosphorus , folate , and iron . A fixed dosage of 5 mL per child was given daily from 30 to 284 days of age . Household visits were made 6 days per week to provide the syrup and conduct surveillance for illness and death . When a child 's death was reported , parental reports and medical records were used to ascertain the cause . The effects of zinc and of the combination of iron , folate , calcium , and phosphorus were analyzed by intent to treat . The mortality analysis was performed using a survival analytic approach that models time until death as the dependent variable ; all models had 2 terms as independent variables : 1 for the zinc effect and 1 for the vitamin and mineral ( calcium and phosphorus , folate and iron ) effect . RESULTS Zinc supplementation was associated with significantly lower mortality , with a rate ratio of 0.32 ( 95 % confidence interval : 0.12 - 0.89 ) . Calcium , phosphorus , folate , and iron supplementation was not associated with a mortality reduction , although a statistically nonsignificant trend toward reduction was observed with a rate ratio of 0.88 ( 95 % confidence interval : 0.36 - 2.15 ) . CONCLUSIONS  Zinc supplementation in small for gestational age infants can result in a substantial reduction in infectious disease mortality Objective : To test whether zinc supplementation reduces the deficits in mental development and behaviour that are found in term infants of low birth weight in the study population . Design : A prospect i ve double-blind , part-r and omised efficacy trial . Setting : A low-income population in Pernambuco , northeast Brazil , where the economy is largely dependent on sugar-cane production , and where over 90 % of deliveries occur in health facilities . Subjects : During a 20-month period , all singleton , term infants weighing 1500–2499 g born to families of low income ( < US $ 280/month ) were enroled at birth ( n=205 ) . At 6 and 12-months , the numbers tested were 163 and 138 respectively . Intervention : Infants born from January 1993–January 1994 were r and omly assigned to receive daily , except Sundays , a placebo ( n=66 ) or 1 mg zinc ( n=68 ) . Those born February – August 1994 were given 5 mg zinc ( n=71 ) . Supplementation was for eight weeks , starting at birth . Field workers visited each infant at home to administer the supplement . Results : At 6 and 12-months , mental and psychomotor development was assessed with the Bayley Scales of Infant Development and no significant differences in the scores of the three groups were found . At 12-months , behaviour was also assessed on 5 ratings . Ratings were highest in infants given 5 mg zinc ( P=0.042 ) . Conclusions : Zinc supplementation ( 5 mg/d ) for eight weeks may reverse some of the poor behaviours , particularly responsiveness , exhibited by low birth weight infants . No amelioration of their mental and psychomotor deficits was found . Sponsorship : The Wellcome Trust , United Kingdom , provided financial support ( Grant no. 036605/Z/92 ) . Dr Lira was supported by CAPES ( Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ) , Brazil BACKGROUND Maternal zinc deficiency during pregnancy may be widespread among women in developing countries , but few data are available on whether prenatal zinc supplementation improves maternal and neonatal zinc status . OBJECTIVE We studied whether maternal zinc supplementation improved the zinc status of mothers and neonates participating in a supplementation trial in a shantytown in Lima , Peru . DESIGN Beginning at gestation week 10 - 24 , 1295 mothers were r and omly assigned to receive prenatal supplements containing 60 mg Fe and 250 microg folate , with or without 15 mg Zn .  Venous blood and urine sample s were collected at enrollment , at gestation week 28 - 30 , and at gestation week 37 - 38 . At birth , a sample of cord vein blood was collected . We measured serum zinc concentrations in 538 women , urinary zinc concentrations in 521 women , and cord zinc concentrations in 252 neonates . RESULTS At 28 - 30 and 37 - 38 wk , mothers receiving zinc supplements had higher serum zinc concentrations than mothers who did not receive zinc ( 8.8 + /- 1.9 compared with 8.4 + /- 1.5 micromol/L and 8.6 + /- 1.5 compared with 8.3 + /- 1.4 micromol/L , respectively ) . Urinary zinc concentrations were also higher in mothers who received supplemental zinc ( P < 0.05 ) . After adjustment for covariates and confounding factors , neonates of mothers receiving zinc supplements had higher cord zinc concentrations than neonates of mothers who did not receive zinc ( 12.7 + /- 2.3 compared with 12.1 + /- 2.1 micromol/L ) . Despite supplementation , maternal and neonatal zinc concentrations remained lower than values reported for well-nourished population s. CONCLUSION Adding zinc to prenatal iron and folate tablets improved maternal and neonatal zinc status , but higher doses of zinc are likely needed to further improve maternal and neonatal zinc status in this population BACKGROUND Undernourished children have poor levels of development that benefit from stimulation . Zinc deficiency is prevalent in undernourished children and may contribute to their poor development . OBJECTIVE We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children . DESIGN This was a r and omized controlled trial with 4 groups : stimulation alone , zinc supplementation alone , both interventions , and control ( routine care only ) .  Subjects were 114 children aged 9 - 30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics . Clinics were r and omly assigned to receive stimulation or not ; individual children were r and omly assigned to receive zinc or placebo . The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged . The supplementation was 10 mg Zn as sulfate daily or placebo .  Development ( assessed by use of the Griffiths Mental Development Scales ) , length , and weight were measured at baseline and 6 mo later . Weekly morbidity histories were taken . RESULTS Significant interactions were found between zinc supplementation and stimulation . Zinc benefited the developmental quotient only in children who received stimulation , and benefits from zinc to h and and eye coordination were greater in stimulated children . Zinc supplementation alone improved h and and eye coordination , and stimulation alone benefited the developmental quotient , hearing and speech , and performance . Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth . CONCLUSION Zinc supplementation benefits development in undernourished children , and the benefits are enhanced if stimulation is also provided BACKGROUND Iron and zinc deficiency are prevalent during infancy in low-income countries . OBJECTIVES The objectives were to examine whether a weekly supplement of iron , zinc , iron+zinc , or a micronutrient mix ( MM ) of 16 vitamins and minerals would alter infant development and behavior . DESIGN The participants were 221 infants from rural Bangladesh at risk of micronutrient deficiencies .  Development and behavior were evaluated at 6 and 12 mo of age by using the Bayley Scales of Infant Development II and the Home Observation Measurement of Environment ( HOME ) scale . In this double-blind trial , the infants were r and omly assigned to 1 of 5 treatment conditions : iron ( 20 mg ) , zinc ( 20 mg ) , iron+zinc , MM ( 16 vitamins and minerals , including iron and zinc ) , or riboflavin weekly from 6 to 12 mo . Multivariate analyses were conducted to examine the change in development and behavior for each supplementation group , with control for maternal education , HOME score , months breastfed , anemia , growth at 6 mo , and change in growth from 6 to 12 mo . RESULTS Iron and zinc administered together and with other micronutrients had a beneficial effect on infant motor development .  Iron and zinc administered individually and in combination had a beneficial effect on orientation-engagement . Two-thirds of the infants were mildly anemic , no treatment effects on hemoglobin concentration were observed , and hemoglobin was not associated with measures of development or behavior . CONCLUSION The beneficial effects of weekly iron and zinc supplementation on motor development and orientation-engagement suggest that infants benefit from these minerals when administered together Zinc deficiency has been associated with growth deficits , reduced dietary intake and appetite , and has been hypothesized to result in reduced activity . This r and omized , double-blind , placebo-controlled study examined whether 10 mg of oral zinc as zinc sulfate , given daily for up to 7 mo , affected activity patterns of 85 Guatemalan infants recruited at 6 - 9 mo of age . Infant activity was assessed by time sampling-observation method at 10-min intervals during a 12-h data collection period , at base line , 3 and 7 mo follow-up . Motor development and the percentage of time infants were observed in various positions ( being carried , lying down , sitting , crawling , st and ing or walking ) and engaged in various activities ( eating , sleeping , resting , crying/whining or playing ) were compared by treatment group . No differences in motor development were observed by treatment group . However , at follow-up 2 ( after 7 mo of supplementation ) , zinc-supplemented infants were significantly more frequently observed sitting up compared with lying down , and were playing during 4.18 + /- 1.95 % ( P < 0.05 ) more observations than unsupplemented infants . They were also somewhat less likely to be observed crying or whining ( P < 0.10 ) compared with those receiving the placebo . These effects are independent of other factors including infant age , motor development , sex , maternal education , family socioeconomic status and nutritional status at base line . Further research must be conducted to determine the long-term developmental importance of these differences in activity patterns associated with zinc supplementation in this setting BACKGROUND It has been documented that growth patterns differ between breastfed and formula-fed infants . Some investigators have suggested that these differences may be related to differences in zinc nutriture . OBJECTIVE The objective of this study was to examine the effect of zinc supplementation on growth , morbidity , and motor development in healthy , term , breastfed infants . DESIGN We conducted a r and omized double-blind intervention comparing zinc supplementation ( 5 mg/d as zinc sulfate ) with placebo in breastfed infants aged 4 - 10 mo .  Growth and indexes of body composition and gross motor development were measured monthly from 3 to 10 mo . Morbidity data were collected weekly . RESULTS Eighty-five infants were enrolled , and 70 completed the study . The baseline characteristics , attained weight or length at 10 mo , growth velocity , gross motor development , and morbidity did not differ significantly between groups , even after control for potentially confounding variables . CONCLUSIONS The dietary zinc intake of these breastfed infants appeared to be adequate , given that zinc supplementation did not affect growth , development , or risk of infection ( although sample size for detection of differences in development or infection was limited ) . Previously described differences in growth between breastfed and formula-fed infants in such population s do not appear to be due to differences in zinc nutriture Changes in growth , body composition , and zinc indexes were evaluated after 25 wk in a double-blind zinc-supplementation study of 162 periurban Guatemalan children aged 81.5 + /- 7.0 mo ( mean + /- SD ) . Children receiving the zinc supplement ( 10 mg Zn/d as amino acid chelate ) for 90.1 + /- 9.2 d had higher mean fasting plasma zinc ( 16.2 + /- 2.9 vs 14.9 + /- 2.1 mumol/L , P < 0.01 ) , a greater increase in median triceps skinfold Z score ( 0.50 vs 0.38 , P < 0.05 ) , and a smaller deficit in median midarm circumference ( MAC ) Z score ( -0.03 vs -0.20 , P < 0.05 ) compared with the placebo group . Initial hair zinc classified as < 1.68 and > 1.68 mumol/g was the only laboratory variable that explained some of the variance in final Z scores of midarm-muscle area ( P < 0.05 ) and MAC ( P < 0.01 ) . Children responded to the zinc supplement with changes in indexes of body composition rather than growth Iron and zinc deficiencies have been associated with delayed motor development in nutritionally at-risk children , albeit inconsistently . In this community-based , r and omized double-blind trial , iron+folic acid ( FeFA ) ( 12.5 mg Fe + 50 mug folic acid ) , zinc ( Zn ) ( 10 mg ) , and iron+folic acid+zinc ( FeFA+Zn ) supplements or a placebo were given daily for 1 y to nutritionally at-risk children in Pemba , Zanzibar . The effects of these treatments on attaining unassisted walking were evaluated using survival analysis for 354 children aged 5 - 11 mo at the start of supplementation . Treatment effects on changes in hemoglobin ( Hb ) and zinc protoporphyrin ( ZPP ) and height-for-age ( HAZ ) and weight-for-age ( WAZ ) Z scores were evaluated using linear regression . Attained motor milestone was recorded every 2 wk for 1 y. Hb , ZPP , HAZ , and WAZ were measured at baseline and after 6 mo of treatment . FeFA with or without Zn reduced the time it took for children to walk assisted . Children who received any iron  walked unassisted sooner than those who received no iron [ median difference approximately 15 d , P = 0.035 , risk ratio ( RR ) = 1.28 , 95 % CI = 1.02 , 1.61 ] and this effect was stronger in those who had iron deficiency anemia ( IDA ) at baseline ( median difference was approximately 30 d ; P = 0.002 ; RR = 1.68 ; 95 % CI = 1.21 , 2.32 ) . FeFA alone and Zn alone improved Hb and ZPP compared with placebo . There were no significant treatment effects on changes in HAZ or WAZ . The effects of treatment on time to walking may have been mediated by improvements in iron status or hemoglobin , but were not mediated through improvements in growth Iron deficiency is prevalent in children and infants worldwide . Zinc deficiency may be prevalent , but data are lacking . Both iron and zinc deficiency negatively affect growth and psychomotor development . Combined iron and zinc supplementation might be beneficial , but the potential interactions need to be verified . In a r and omized , placebo-controlled trial using 2 x 2 factorial design , 609 Thai infants aged 4 - 6 mo were supplemented daily with 10 mg of iron and /or 10 mg of zinc for 6 mo to investigate effects and interactions on micronutrient status and growth . Iron supplementation alone increased hemoglobin and ferritin concentrations more than iron and zinc combined . Anemia prevalence was significantly lower in infants receiving only iron than in infants receiving iron and zinc combined .  Baseline iron deficiency was very low , and iron deficiency anemia was almost nil . After supplementation , prevalence of iron deficiency and iron deficiency anemia were significantly higher in infants receiving placebo and zinc than in those receiving iron or iron and zinc .  Serum zinc was higher in infants receiving zinc ( 16.7 + /- 5.2 micromol/L ) , iron and zinc ( 12.1 + /- 3.8 micromol/L ) or iron alone ( 11.5 + /- 2.5 micromol/L ) than in the placebo group ( 9.8 + /- 1.9 micromol/L ) . Iron and zinc interacted to affect iron and zinc status , but not hemoglobin . Iron supplementation had a small but significant effect on ponderal growth , whereas zinc supplementation did not . To conclude , in Thai infants , iron supplementation improved hemoglobin , iron status , and ponderal growth , whereas zinc supplementation improved zinc status . Overall , for infants , combined iron and zinc supplementation is preferable to iron or zinc supplementation alone BACKGROUND Deficiencies of iron and zinc are associated with delayed development , growth faltering , and increased infectious-disease morbidity during infancy and childhood . Combined iron and zinc supplementation may therefore be a logical preventive strategy . OBJECTIVE The objective of the study was to compare the effects of combined iron and zinc supplementation in infancy with the effects of iron and zinc as single micronutrients on growth , psychomotor development , and incidence of infectious disease . DESIGN Indonesian infants ( n = 680 ) were r and omly assigned to daily supplementation with 10 mg Fe ( Fe group ) , 10 mg Zn ( Zn group ) , 10 mg Fe and 10 mg Zn ( Fe+Zn group ) , or placebo from 6 to 12 mo of age . Anthropometric indexes , developmental indexes ( Bayley Scales of Infant Development ; BSID ) , and morbidity were recorded . RESULTS At 12 mo , two-factor analysis of variance showed a significant interaction between iron and zinc for weight-for-age z score , knee-heel length , and BSID psychomotor development . Weight-for-age z score was higher in the Zn group than in the placebo and Fe+Zn groups , knee-heel length was higher in the Zn and Fe groups than in the placebo group , and the BSID psychomotor development index was higher in the Fe group than in the placebo group . No significant effect on morbidity was found . CONCLUSIONS Single supplementation with zinc significantly improved growth , and single supplementation with iron significantly improved growth and psychomotor development , but combined supplementation with iron and zinc had no significant effect on growth or development . Combined , simultaneous supplementation with iron and zinc to infants can not be routinely recommended at the iron-to-zinc ratio used in this study BACKGROUND Zinc deficiency is thought to be common in young children in developing countries and some data suggest that it may detrimentally affect children 's development . OBJECTIVE Our goal was to assess the effect of zinc supplementation on the developmental levels and behavior of Bangladeshi infants . DESIGN This was a r and omized , double-blind , controlled trial conducted in Dhaka , Bangladesh . Three hundred one infants aged 1 mo were r and omly assigned to receive either 5 mg elemental Zn or placebo daily for 5 mo , and subsequent growth and morbidity were observed . For the present study , developmental levels were assessed in a sub sample of 212 infants at 7 and 13 mo of age with use of the Bayley Scales of Infant Development , and the infants ' behavior during the tests was observed . The children 's social background s , weights , and lengths were also recorded . RESULTS The children 's nutritional status was generally poor . The  zinc-treated group had slightly lower scores on the mental development index of the Bayley Scales than did the placebo group ( beta = 3.7 , SE = 1.3 , P < 0.005 ) . This effect remained significant when nutritional status and social background were controlled for . No other significant differences between groups were noted . CONCLUSIONS The mental development index scores of the zinc-treated group were slightly but significantly lower than those of the placebo group . This finding may have been due to micronutrient imbalance . Caution should be exercised when supplementing undernourished infants with a single micronutrient BACKGROUND Rates of mental illness in children are increasing throughout the world . Observational studies of depression , anxiety , and attention-deficit hyperactivity disorder suggest that zinc is an alternative treatment . OBJECTIVE We examined the effect of zinc supplementation on the mental health of school-age children in Guatemala . DESIGN From January to October 2006 , we conducted a 6-mo r and omized , double-blind , controlled trial comparing zinc supplementation ( 10 mg ZnO/d for 5 d/wk ) with a placebo ( 10 mg glucose ) in 674 Guatemalan children in grade s 1 - 4 . Outcome measures included internalizing ( ie , depression and anxiety ) and externalizing ( ie , hyperactivity and conduct disorder ) problem behaviors , positive behaviors ( ie , socialization and leadership ) , and serum zinc concentrations . RESULTS Zinc and placebo groups did not differ significantly in any behavioral measures at baseline or at follow-up . At baseline , 21.4 % of children had serum zinc concentrations < 65 μg/dL. At follow-up , both groups improved significantly , and zinc concentrations were higher in the zinc group . Increases in serum zinc concentrations were inversely associated with decreases in depressive symptoms ( estimate : -0.01 points per μg Zn/dL ; P = 0.01 ) , anxiety ( estimate : -0.012 points per μg Zn/dL ; P = 0.02 ) , internalizing symptoms ( estimate : -0.021 points per μg Zn/dL ; P = 0.02 ) , and social skills ( estimate : -0.019 points per μg Zn/dL ; P = 0.01 ) in adjusted models that were controlled for child age , sex , socioeconomic status , household , and treatment group . CONCLUSIONS Six months of zinc supplementation did not induce differences in mental health outcomes between zinc and placebo groups . However , increases in serum zinc concentrations were associated with decreases in internalizing symptoms ( ie , depression and anxiety ) in a community-based sample of children at risk of zinc deficiency . This trial was registered at clinical trials.gov as NCT00283660 Objective : To test the efficacy of zinc supplementation through diet or ayurvedic zinc tablet on cognitive function and taste acuity in adolescent girls . Methods : Using zinc-rich food items , snacks were prepared by adopting food-processing methods that enhance zinc bioavailability . Ayurvedic zinc tablet ( jasad bhasma ) was chosen as a natural elemental zinc supplement . Efficacy of snacks and the tablet was assessed in 180 schoolgirls ( 12.5 ± 0.85 years ) from Pune City , India , who were r and omly allocated to any of the 3 groups : ( 1 ) ayurvedic zinc tablet — J , ( 2 ) zinc-rich snacks — D , or ( 3 ) Control — C. Supplementation was given on every school day ( 6 days/wk ) for 10 weeks . All measurements were recorded at baseline and at the end of the study period . Food intake was recorded by 24-hour diet recall on 3 r and om days . Hemoglobin , serum ferritin , and plasma zinc were estimated on a fasting blood sample . Cognitive assessment was done on each participant using tests for simple reaction time ( SRT ) , recognition reaction time ( RRT ) , visual memory , and Raven 's Progressive Matrices ( RPM ) . Taste acuity was determined by recognition thresholds for salt ( RTS ) over a range of 10 different salt concentrations . Results : A higher increase in plasma zinc ( 61.3 % ) was observed in the J group than in the D group ( 9.9 % ) ( p < 0.01 ) , whereas plasma zinc declined in the control group ( −2.2 % ) over baseline ( p > 0.1 ) . Hemoglobin showed no change in all 3 groups ( p > 0.1 ) . Percent increment in scores for memory and RPM was significantly more in the D and J groups ( 24.5%–29.6 % ) than in the C group ( 6.5 % ) ( p < 0.05 ) . Mean SRT and RRT were reduced more in the D and J groups ( 5%–16 % ) than in the C group ( 1.6 % ) ( p < 0.05 ) . A significant fall in median RTS from 5 to 2.5 mmol/L was noted after both diet and zinc supplementation ( p < 0.01 ) ; however , it remained the same at 5 mmol/L in the Control group after 10 weeks . Conclusion : Supplementation of ayurvedic zinc and zinc-rich foods are effective in improving cognitive performance and the recognition threshold for salt of adolescent girls The knowledge that zinc is essential for growth and neuropsychologic performance and a report of zinc-responsive stunting in Chinese children prompted this project . This article summarizes findings from a 10-wk , double-blind , controlled trial of zinc repletion in 740 urban , 6 - 9-y-old first grade rs from low-income families in Chongqing , Qingdao , and Shanghai , People 's Republic of China . Treatments were 20 mg Zn alone ( Z ) , 20 mg Zn with micronutrients ( ZM ) , and micronutrients alone ( M ) . The M mixture was based on National Research Council guidelines . Nutrients that might interfere with zinc retention were excluded or given in lower amounts . Main outcomes were changes in neuropsychologic performance and knee height . Hemoglobin , serum ferritin , plasma and hair zinc , and whole blood and hair lead were also measured . Anemia was not common , and serum ferritin concentrations were usually within the range of normal . Mean baseline plasma zinc concentrations were marginal in children from Chongqing and Qingdao and normal in children from Shanghai . After treatment with ZM or M plasma zinc increased . Hair zinc tended to decrease after all treatments . Mean baseline whole blood lead concentrations were slightly below the limit considered excessive for children by the US Centers for Disease Control and Prevention . Neuropsychologic performance and growth were most improved after treatment with ZM . These findings were consistent with the presence of zinc and other micronutrient deficiencies Although the trace element boron has yet to be recognized as an essential nutrient for humans , recent data from animal and human studies suggest that boron may be important for mineral metabolism and membrane function . To investigate further the functional role of boron , brain electrophysiology and cognitive performance were assessed in response to dietary manipulation of boron ( approximately 0.25 versus approximately 3.25 mg boron/2000 kcal/day ) in three studies with healthy older men and women . Within-subject design s were used to assess functional responses in all studies . Spectral analysis of electroencephalographic data showed effects of dietary boron in two of the three studies . When the low boron intake was compared to the high intake , there was a significant ( p < 0.05 ) increase in the proportion of low-frequency activity , and a decrease in the proportion of higher-frequency activity , an effect often observed in response to general malnutrition and heavy metal toxicity . Performance ( e.g. , response time ) on various cognitive and psychomotor tasks also showed an effect of dietary boron . When contrasted with the high boron intake , low dietary boron result ed in significantly poorer performance ( p < 0.05 ) on tasks emphasizing manual dexterity ( studies II and III ) ; eye-h and coordination ( study II ) ; attention ( all studies ) ; perception ( study III ) ; encoding and short-term memory ( all studies ) ; and long-term memory ( study I ) . Collectively , the data from these three studies indicate that boron may play a role in human brain function and cognitive performance , and provide additional evidence that boron is an essential nutrient for humans OBJECTIVE To evaluate the effect of zinc supplementation on growth and development during infancy .  DESIGN We r and omized 150 term neonates of low socioeconomic status to receive supplemental zinc 5 mg/d  ( SG ) or a lactose placebo  ( PG ) ; 112 completed a 1-year follow-up . All were breast-fed and given cow milk formula after weaning ; solid foods and iron were added at 5 months . Anthropometry measured monthly , psychomotor development ( PDI ) , mental development ( MDI ) , and behavior including motor quality factor were assessed by Bayley Scales at 6 and 12 months . The groups were comparable in maternal characteristics , birth weight , home environment , and mother-infant interaction . RESULTS No effects of zinc on weight , length , and weight for length at 12 months were found controlling for sex and breast-feeding . The mean PDI ( SG : 84.5 + /- 11.5 vs PG : 87.6 + /- 9.9 ) and MDI ( 90.9 + /- 10.5 vs 88.9 + /- 9.1 ) were similar ; however , 46 of 52 infants in the PG scored < 100 in MDI vs 42 of 57 in the SG ( P < .05 ) . A smaller proportion of the SG , 2 of 57 , scored low in motor quality factor at 6 months compared with the PG , 8 of 52 ( P = .02 ) . The mean at 12 months for the SG was 31.9 + /- 2.8 and for the PG 30.8 + /- 2.9 ( P < .05 ) ; zinc supplementation entered the multiple regression at 12 months ( P = .037 ) . CONCLUSIONS Zinc supplementation may have a beneficial effect on mental development and motor quality behavior of healthy term infants A community-based , cluster-r and omized , placebo-controlled trial of daily zinc and /or iron+folic acid supplementation was conducted in rural southern Nepal to examine  motor milestone attainment among 3264 children 1 - 36 mo of age between 2001 and 2006 . Treatment groups included placebo , zinc ( 10 mg ) , iron+folic acid ( 12.5 mg iron + 50 microg folic acid ) , and zinc+iron+folic acid ( 10 mg zinc + 12.5 mg iron + 50 microg folic acid ) . Infants received half of these doses . The iron arms were stopped November 2003 by recommendation of the Data Safety and Monitoring Board ; zinc and placebo continued until January 2006 . A total of 2457 children had not walked at the time of entry into the trial and 1775 were followed through 36 mo .  Mean age at first walking unassisted did not differ among groups and was 444 + /- 81 d ( mean + /- SD ) in the placebo group , 444 + /- 81 d in the zinc group , 464 + /- 85 d in the iron+folic acid group , and 446 + /- 87 d in the iron+folic acid+zinc group . Results were similar after adjustment for age at enrollment , asset ownership , maternal literacy , and prior child deaths in the household and in children who consumed at least 60 tablets . Compared with placebo , iron+folic acid was associated with an adjusted mean delay of 28.0 d ( 95 % CI : 11.3 , 44.7 ) in time to walking among infants and the delay was more pronounced with mid-upper arm circumference ( MUAC ) < 9.5 cm [ 60.6 d , ( 95 % CI : 28.5 , 92.6 ) ] . Risks and benefits of universal iron+folic acid supplementation of infants beyond improved hematologic status deserve further consideration Inadequate zinc intake may lead to poor growth and developmental outcome in very-low-birth-weight ( VLBW ; < 1,500 g ) infants . Fifty-two infants ( mean birth weight , 1,117 + /- 287 g ; mean gestational age , 29 + /- 2.9 weeks ) were r and omly allocated to two groups . SUPP infants received a regular term formula plus zinc supplements ( 4.4 mg/L ; final content , 11 mg/L ) ; PLAC infants received the same formula plus placebo ( final content , 6.7 mg/L ) . Infants started their formula at 1,853 + /- 109 g and consumed the formula for 6 months . All subjects were evaluated at 3 , 6 , 9 , and 12 + /- 0.75 months corrected-for-gestational-age . At each evaluation , weight , length , and head circumference were measured , a Griffiths developmental assessment was performed , and a blood sample was taken . Higher plasma zinc levels ( p < 0.05 ) were found in the SUPP group at 1 and 3 months , and improved linear growth velocity was found in the SUPP group over the study period for the whole group as well as for girls alone . Maximum motor development scores were higher ( p = 0.018 ) in the SUPP ( 98 + /- 10 ) than the PLAC ( 90 + /- 8) group , indicating that increased zinc intake in early infancy may be beneficial to VLBW infants OBJECTIVE . Lead exposure in children has been associated with both global and specific cognitive deficits . Although chelation therapy is advised for children with blood lead concentrations of > 44 μg/dL , treatment options for children with lower blood lead values are limited . Because lead absorption is related to children 's nutritional status , micronutrient supplements may be 1 strategy for combating low-level , chronic lead exposure . This study was design ed to test the efficacy of iron and zinc supplementation for lowering blood lead concentrations and improving cognitive performance in schoolchildren who live in a lead-contaminated city . METHODS . This r and omized , double-blind , placebo-controlled field trial was conducted in public elementary schools in Torreón , an industrialized city in northern Mexico . A metal foundry , located close to the city center and within 3.5 km of 9 schools , was the main source of lead exposure . A total of 602 children who were aged 6 to 8 years and regularly attending first grade in the study schools were enrolled . Children were given 30 mg of iron , 30 mg of zinc , both , or a placebo daily for 6 months . A total of 527 completed the treatment , and 515 were available for long-term follow-up , after another 6 months without supplementation . Eleven cognitive tests of memory , attention , visual-spatial abilities , and learning were administered at baseline and each follow-up . RESULTS . There were no consistent or lasting differences in cognitive performance among treatment groups . CONCLUSIONS . Daily supplementation with iron and /or zinc may be of limited usefulness for improving cognition in lead-exposed schoolchildren . However , these treatments may be effective in setting s with higher prevalence of nutritional deficiencies or in younger children OBJECTIVE To determine the efficacy of iron and zinc supplementation on behavior ratings of lead-exposed children . STUDY DESIGN In this double-blind , r and omized trial , 602 first- grade children received 30 mg ferrous fumarate , 30 mg zinc oxide , both , or placebo daily for 6 months . Lead , iron , and zinc status were determined at baseline and follow-up . Parents and teachers provided ratings of child behavior using the Conners Rating Scales . RESULTS The baseline mean ( SD ) blood lead concentration was 11.5 ( 6.1 ) mug/dL , with 51 % of children > or = 10 microg/dL. The prevalence of attention deficit hyperactivity disorder , estimated by combined parent and teacher ratings , was 6 % . At follow-up , parent ratings of oppositional , hyperactive , cognitive problems , and attention deficit hyperactivity disorder decreased by 1.5 , 1.2 , 2.5 , and 3.4 points , respectively ( P < .05 ) . Teacher ratings of hyperactivity increased by 1.1 points ( P = .008 ) , and the mean cognitive problem score declined by 0.7 points ( P = .038 ) . There were no treatment effects on mean change in scores , but children receiving any zinc had a higher likelihood of no longer receiving clinical ly-significant teacher ratings of oppositional behaviors . CONCLUSIONS This regimen of supplementation did not result in consistent improvements in ratings of behavior in lead-exposed children over 6 months OBJECTIVES To investigate whether supplementation of zinc in preschool children is associated with improvement in observed activity levels . METHODS On 2 consecutive days , we performed 5-hour observations with momentary time sampling ( instant activity every 10 minutes ) in children selected from an ongoing double-blind , r and omized trial of zinc supplementation .  The study was conducted in Kalkaji , a low-socioeconomic urban population of New Delhi with high diarrheal incidence and rates of malnutrition . A total of 93 children ( 48 zinc and 45 control ) 12 to 23 months of age from an ongoing community-based , r and omized , controlled trial received supplements for at least 1 month before study ; 71 % had received supplementation for more than 120 days .  Zinc gluconate ( 10 mg of elemental zinc ) was given daily , with both zinc and control groups receiving vitamins A , B1 , B2 , B6 , D3 , and E and niacinamide in addition . RESULTS Outcomes were percentages of time spent in each of five activity levels and two groups representing high and low movement and overall rating by two activity scores . Children in the zinc group spent 72 % more time performing activities in the high-movement group . Among the zinc-supplemented children , the activity rating by the children 's activity rating score was 12 % higher and by the energy expenditure score was 8.3 % higher than in the control group . CONCLUSIONS In conclusion , zinc supplementation , given along with selected vitamins , was associated with significantly greater activity levels in children . The relationship between the activity increase and locomotor development needs to be investigated , as do the long-term implication s of zinc supplementation in terms of developmental status and school performance OBJECTIVE Zinc is essential for growth and cognition of experimental animals . Past research found zinc repletion improved growth of stunted Chinese children . Therefore we measured effects of zinc repletion on growth and neuropsychological functions of children . DESIGN Double-blind r and omized controlled treatment trial . SETTING Elementary schools in low income districts of Chongqing , Qingdao and Shanghai . SUBJECTS Three hundred-seventy-two 6 to 9 year old first grade rs . INTERVENTIONS Treatments were 20 mg zinc , 20 mg zinc with micronutrients , or micronutrients alone . The micronutrient mixture was based on guidelines of the US NAS/NRC . Treatments were assigned to classrooms of 40 or more children each , and administered by teachers 6 days per week for 10 weeks . MEASURES OF OUTCOME Changes in knee height and neuropsychological functions . RESULTS Zinc alone had the least effect on growth while zinc with micronutrients had the largest effect ; micronutrients alone had an intermediate effect . Zinc-containing treatments improved neuropsychological functions , but micronutrients alone had little effect . CONCLUSIONS The findings confirm the essentiality of zinc for growth of children , and show , for the first time , the essentiality of zinc for neuropsychological functions of children . In addition , the need for repletion of other potentially limiting nutrients in studies examining the effects of specific nutrients on growth and neuropsychological functions was confirmed OBJECTIVE To evaluate the effect of zinc supplementation on mental and psychomotor scores in children aged 12 to 18 months . STUDY DESIGN In this double-blind , r and omized , placebo-controlled trial , children aged 6 to 30 months received daily elemental zinc ( 10 mg for infants and 20 mg for others ) or placebo for 4 months . Bayley Scales of Infant Development II were used for development assessment in the 12- to 18-month subgroup at enrollment and the end of the study . RESULTS At the end of the study , the adjusted mean mental ( P = .36 ) and psychomotor ( P = .28 ) index scores were similar in the intervention and control groups . In a multivariate model , the baseline mental development index score was positively associated with the mother 's schooling , the child 's height for age , packed cell volumes , hospital birth , and attendance at a day care center , and was negatively associated with the child 's age . Breastfeeding , the child 's weight for height , and packed cell volumes were positively associated with the baseline psychomotor index score . CONCLUSION Zinc supplementation did not affect the mental or psychomotor development index scores in a setting in which zinc deficiency is common OBJECTIVE Infants who are born small for gestational age ( SGA ) are at risk for developmental delays , which may be related to deficiencies in zinc , an essential trace metal , or to deficiencies in their ability to elicit caregiver responsiveness ( functional isolation hypothesis ) . The objective of this study was to evaluate at 6 and 10 months of age the impact of a 9-month supplementation trial of 5 mg of zinc on the development and behavior of infants who were born SGA and to evaluate infants ' ability to elicit responsive caregiver behavior . METHODS A r and omized , controlled trial of zinc supplementation was conducted among 200 infants in a low-income , urban community in Delhi , India . Infants were recruited when they were full term ( > 36 weeks ) and SGA ( birth weight < 10th percentile weight-for-gestational age ) . Infants were r and omized to receive daily supplements of a micronutrient mix ( folate , iron , calcium , phosphorus , and riboflavin ) with or without 5 mg of zinc sulfate . The supplement was administered by field workers daily from 30 days to 9 months of age . At 6 and 10 months , infant development and behavior were measured in a clinical setting using the Bayley Scales of Infant Development II . Caregiver responsiveness , observed on an Indian version of the Home Observation for Measurement of the Environment scale , was measured during a home visit at 10 months . During both the clinic and home visits , caregivers reported on their infant 's temperament . RESULTS There were no direct effects of zinc supplementation on the infants ' development or behavior at either 6 or 10 months . In a subgroup analysis among the zinc-supplemented infants , lower birth weight infants were perceived to be more temperamentally difficult than higher weight infants ; in the control group , birth weight was not associated with temperament . Heavier birth weight infants had better scores on all measures of development and behavior at 6 months and on changes in mental and motor development from 6 to 10 months , compared with lighter birth weight infants . Boys had better weight gain and higher scores on mental development and emotional regulation than girls . Infants who were from families of higher socioeconomic status ( indexed by parental education , house size , and home ownership ) had higher scores on mental development and orientation/engagement ( exploratory behavior ) than infants who were from families of lower socioeconomic status . In keeping with the functional isolation hypothesis , caregiver responsiveness was associated with infant irritability , controlling for socioeconomic status , gender , birth weight , and weight gain . Responsive mothers were more likely to perceive their infants to be temperamentally easy than less responsive mothers . CONCLUSION Possible explanations for the lack of effects of zinc supplementation on infant development and behavior include 1 ) subtle effects of zinc supplementation that may not have been detected by the Bayley Scales , 2 ) interference with other nutritional deficiencies , or 3 ) no impact of zinc deficiency on infants ' development and behavior . The link between birth weight and irritability among infants in the zinc supplementation group suggests that the response to zinc supplementation may differ by birth weight , with irritability occurring among the most vulnerable infants . Longer term follow-up studies among zinc-supplemented infants are needed to examine whether early supplementation leads to developmental or behavioral changes that have an impact on school-age performance . The relationship between infant irritability and low maternal responsiveness lends support to the functional isolation hypothesis and the importance of asking caregivers about infant temperament OBJECTIVE Our objective was to examine whether improvement in maternal zinc status during pregnancy is positively associated with fetal neurobehavioral development  in a Peruvian population . STUDY DESIGN We electronically monitored , at 32 and 36 weeks ' gestation , 55 fetuses whose mothers were r and omly assigned to receive , during pregnancy , a daily supplement containing 60 mg iron and 250 microg folate , with or without 15 mg zinc .  Fetal heart rate and movement patterns were quantified in 55 and 34 fetuses , respectively , as indexes of neurobehavioral development . RESULTS Fetuses of mothers who received zinc supplementation showed fewer episodes of minimal fetal heart rate variability , increased fetal heart rate range , an increased number of accelerations , an increased number of movement bouts , an increased amount of time spent moving , and an increased number of large movements . Differences by supplementation type increased with gestational age and were statistically significant at 36 weeks ' gestation ( P < .05 ) . CONCLUSION Improving maternal zinc status through prenatal supplementation may improve fetal neurobehavioral development The relation of zinc ( Zn ) nutriture to brain development and function has been eluci date d. The purpose of this study is to examine whether Zn supplementation improves mood states in young women . The study used a double-blind , r and omized and placebo-controlled procedure . The major outcomes were psychological measures , somatic symptoms and serum Zn .  Thirty women were placed r and omly and in equal numbers into two groups , and they ingested one capsule containing multivitamins ( MVs ) or MV and 7 mg Zn daily for 10 weeks . Women who took MV and Zn showed a significant reduction in anger – hostility score ( P=0.009 ) and depression – dejection score ( P=0.011 ) in the Profile of Moods State ( POMS ) and a significant increase in serum Zn concentration ( P=0.008 ) , whereas women who took only MV did not . Our results suggest that Zn supplementation may be effective in reducing anger and depression BACKGROUND Iron and zinc are important micronutrients for child growth and development . One would expect that iron and zinc supplementation in infancy would affect long-term cognitive development and school achievement , but this has not been evaluated . OBJECTIVE We investigated the effect of iron or zinc supplementation or both during infancy on cognitive performance 8 y later . DESIGN A follow-up study was performed in 560 children aged 9 y or 92 % of those who had participated in a r and omized controlled trial involving 4 groups who received daily iron , zinc , iron plus zinc , or a placebo at 4 - 6 mo of age for 6 mo .  Cognitive performance was assessed by using the Wechsler Intelligence Scale for Children-Third Edition ( Thai version ) , the Raven 's Colored Progressive Matrices ( CPM ) , and school performance tests . General linear mixed models were used to assess long-term effects . RESULTS No significant differences in any of the outcomes at 9 y of age were observed at follow-up between the 4 groups . Mean intelligence quotients ranged across groups from 92.9 to 93.7 for full scale , 93.9 - 95.4 for verbal , and 93.1 - 94.0 for performance . The Raven 's CPM score ranged from 21.4 to 22.4 . CONCLUSION Supplementation with iron or zinc or both during infancy does not lead to long-term cognitive improvement in 9-y-old children . This trial was registered at clinical trials.gov as NCT00824304 Adolescents with anorexia nervosa were evaluated for clinical and biochemical evidence of  zinc  deficiency . To assess whether these patients would benefit from zinc supplementation , a double-blind , r and omized , controlled trial was conducted . The mean zinc intake of the anorexic group calculated on the basis of three-day dietary records was 7.7 + /- 5.2 mg/day , which is significantly below the recommended daily allowance of 15 mg for adolescents ( p less than 0.001 ) . The mean urinary zinc excretion in the anorexic group was 257.1 + /- 212.7 micrograms/24 hours compared to 749.9 + /- 897.8 micrograms/24 hours in the control group ( p less than 0.005 ) . This result suggests that the zinc status of anorexia nervosa patients may be compromised due to an inadequate zinc intake . Zinc supplementation ( 50 mg elemental zinc/day ) was followed by a decrease in the level of depression and anxiety as assessed by the Zung Depression Scale ( p less than 0.05 ) and the State-Trait Anxiety Inventory ( p less than 0.05 ) , respectively . Our data suggest that individuals with anorexia nervosa may be at risk for zinc deficiency and may respond favorably after zinc supplementation A double-blind , pair-matched 12-mo study examined the effects of a zinc supplement ( 10 mg Zn/d as ZnSO4 ) on linear growth , taste acuity , attention span , biochemical indices , and energy intakes of 60 boys ( aged 5 - 7 y ) with height less than or equal to 15th and midparent height greater than 25th percentiles . Boys with initial hair Zn less than 1.68 mumol/g ( n = 16 ) had a lower mean ( + /- SD ) weight-for-age Z score ( -0.44 + /- 0.59 vs -0.08 + /- 0.84 ) , and a higher median recognition threshold for salt ( 15 vs 7.5 mmol ; p = 0.02 ) than those with hair Zn greater than 1.68 mumol/g . Only boys with hair Zn less than 1.68 mumol/g responded to the Zn supplement with a higher mean change in height-for-age Z score ( p less than 0.05 ) ; taste acuity , energy intakes , and attention span were unaffected . A growth-limiting Zn deficiency syndrome exists in boys with low height percentiles , hair Zn levels less than 1.68 mumol/g , and impaired taste acuity Background : There is some evidence that sleep patterns may be affected by iron deficiency anemia but the role of iron in sleep has not been tested in a r and omized iron supplementation trial . Objective : We investigated the effect of iron supplementation on maternal reports of sleep in infants in 2 r and omized , placebo-controlled trials from Pemba Isl and , Zanzibar , and Nepal . Design : In both studies , which had parallel design s and were carried out in years 2002 to 2003 , infants received iron – folic acid with or without zinc daily for 12 months , and assessment s of development were made every 3 months for the duration of the study . Eight hundred seventy-seven Pemban ( 12.5 ± 4.0 months old ) and 567 Nepali ( 10.8 ± 4.0 months ) infants participated .  Maternal reports of sleep patterns ( napping frequency and duration , nighttime sleep duration , frequency of night waking ) were collected . Results : Mean Hb concentration was 9.2 ± 1.1 for Pemban and 10.1 ± 1.2 g/dL for Nepali infants . Approximately , one-third of the children were stunted . Supplemental iron was consistently associated with longer night and total sleep duration . The effects of zinc supplementation also included longer sleep duration . Conclusions : Micronutrient supplementation in infants at high risk for iron deficiency and iron deficiency anemia was related to increased night sleep duration and less night waking
target: There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development
background: BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries .
  Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses .
  Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) .
  Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency .
  OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .