title: Utilization of the PICO framework to improve searching PubMed for clinical questions Effectiveness of Zinc Supplementation to Full Term Normal Infants: A Community Based Double Blind, Randomized, Controlled, Clinical Trial A 14-mo zinc-supplementation trial in apparently healthy Chilean preschool children. Effect of zinc supplementation on growth and body composition in children with sickle cell disease. Effect of zinc supplementation on growth and body composition of Ugandan preschool children: a randomized, controlled, intervention trial. Plasma zinc, rate of weight gain, and the energy cost of tissue deposition in children recovering from severe malnutrition on a cow's milk or soya protein based diet. Zinc supplementation increases growth and circulating insulin-like growth factor I (IGF-I) in growth-retarded Vietnamese children. Additional zinc delivered in a liquid supplement, but not in a fortified porridge, increased fat-free mass accrual among young Peruvian children with mild-to-moderate stunting. Zinc supplementation improves the growth of stunted 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. Longitudinal measures of circulating leptin and ghrelin concentrations are associated with the growth of young Peruvian children but are not affected by zinc supplementation. Effects of multivitamin and mineral supplementation on adiposity, energy expenditure and lipid profiles in obese Chinese women Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial Zinc supplementation in infants with asymmetric intra uterine growth retardation; effect on growth, nutritional status and leptin secretion. Longitudinal measurements of zinc absorption in Peruvian children consuming wheat products fortified with iron only or iron and 1 of 2 amounts of zinc. A trial of zinc supplementation in young rural Gambian children. Association of low plasma concentrations of antioxidant vitamins, magnesium and zinc with high body fat per cent measured by bioelectrical impedance analysis in Indian men. Effect of zinc supplementation on serum leptin levels and insulin resistance of obese women The impact of zinc supplementation on growth and body composition: A randomized, controlled trial among rural Zimbabwean schoolchildren Interrelationship of indices of body composition and zinc status in 11-yr-old New Zealand children Zinc supplementation increases growth velocity of male children and adolescents with short stature Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican preschoolers. The effect of zinc supplementation on linear growth, body composition, and growth factors in preterm infants. Zinc supplementation in infants with a nutritional pattern of failure to thrive: a double-blind, controlled study.
abstract: Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results The study was aim ed to test whether zinc supplementation , if initiated early , can prevent stunting and promote optimum body composition in full term infants . For this , full term pregnant women from low income urban community were enrolled and were followed-up for 24 months postpartum . Body mass index ( BMI ) was calculated from maternal weight and height that were collected one month after delivery . Infants ' weight , and length , head , chest and mid upper arm circumferences and skin fold thicknesses at triceps , biceps and subscapular area were collected at baseline ( before r and omization ) and once in three months up till 24 months . Three hundred and twenty four infants were r and omized and allocated to zinc ( 163 ) or placebo ( 161 ) groups respectively . Supplementation of zinc was initiated from 4 months of age and continued till children attained 18 months . The control ( placebo ) group of children received riboflavin 0.5 mg/day , whereas the intervention ( zinc ) group received 5 mg zinc plus riboflavin 0.5 mg/day . When infants were 18 months old , dietary intakes ( in 78 children ) were calculated by 24 hour diet recall method and hemoglobin , zinc , copper and vitamin A were quantified in blood sample s collected from 70 children . The results showed prevalence of undernutrition ( body mass index < 18.5 ) in 37 % of the mothers . Mean±SD calorie consumption and zinc intakes from diets in infants were 590±282.8 Kcal/day and 0.97±0.608 mg/day respectively . Multiple linear regression models demonstrated maternal weight as a strong predictor of infants ' weight and length at 18 months of age . As expected , diarrhea duration impacted infants ' linear growth and weight gain adversely . Zinc supplementation for a mean period of 190 days , starting from 4 months up to 18 months of age , in full term normal infants , consuming an average energy of 590 Kcal/day , had significant effect on the skin fold thicknesses , but not on their linear growth . Trial Registration Clinical Trail Registration India ( CTRI ) Apparently healthy preschool children ( 46 boys , 52 girls ) aged 27 - 50 mo from low socioeconomic conditions who attended daycare centers in Santiago participated in a 14-mo long double-blind zinc supplementation trial . Unlike most previous studies , no additional inclusion criteria such as short stature or slow growth rate were considered . Subjects were pair matched according to sex and age and r and omly assigned to two experimental groups : the supplemented group , which received 10 mg Zn/d , and the placebo group . Selected anthropometric , clinical , dietary , biochemical , and functional indexes were determined at the beginning of the study and after 6 and 14 mo of intervention . Actual dietary zinc intake was 66 % of the recommended dietary allowance . Height gain after 14 mo was on average 0.5 cm higher in the supplemented group ( P = 0.10 ) . The response , however , was different between sexes . Boys from the supplemented group  gained 0.9 cm more than those in the placebo group ( P = 0.045 ) . No effect was seen in girls . Although no significant differences were observed in the rest of the variables studied , trends ( 0.05 < P < 0.10 ) in the supplemented group compared with the placebo group for increased midarm muscle area in boys , improved response to tuberculin , and reduced rates of parasite reinfestation were noted . We conclude that in preschool children of low socioeconomic status , zinc is a limiting factor in the expression of growth potential BACKGROUND Poor growth and delayed maturation in children with sickle cell disease ( SCD ) may be due , in part , to mild zinc deficiency . OBJECTIVE The objective was to determine the effects of zinc supplementation on growth and body composition in children with SCD . DESIGN Forty-two prepubertal children ( 20 girls and 22 boys ) aged 4 - 10 y with SCD-SS were r and omly assigned to receive 10 mg elemental Zn/d in cherry syrup ( zinc group ) or cherry syrup alone ( control group ) . The 2 groups were stratified by sex and initial height status . Dietary intakes were evaluated and anthropometric , high-precision knee-height , and plasma zinc measurements were made at baseline and at 3 , 6 , and 12 mo . Body composition was determined every 6 mo with dual-energy X-ray absorptiometry , and z scores for anthropometric variables were computed from national reference data . Longitudinal-mixed-effects analysis was used to test for differences between the groups over the 12-mo observation period . RESULTS Thirty-eight children completed the study . No significant differences were observed at baseline . After 12 mo , the zinc group had significantly greater mean ( + /- SE ) increases in height ( 0.66 + /- 0.29 cm/y ) , sitting height ( 0.97 + /- 0.40 cm/y ) , knee height ( 3.8 + /- 1.2 mm/y ) , and arm circumference z scores ( 0.27 + /- 0.12 cm/y ) . Height-for-age and weight-for-age z scores decreased significantly by 0.11 + /- 0.04 and 0.13 + /- 0.05 , respectively , in the control group but did not change significantly in the zinc group . CONCLUSIONS Prepubertal children with SCD-SS may have zinc deficiency and may benefit from zinc supplementation to improve linear growth and weight gain BACKGROUND Despite ample food supplies , the incidence of childhood underweight and stunting remains high in Ug and a. Many factors contribute to this situation , but the role of low zinc intakes has not been adequately explored . OBJECTIVE Our objective was to study the effect of zinc supplementation on growth and body composition of preschool children by using the outcome measures of weight , height , and midupper arm circumference ( MUAC ) . DESIGN The study was r and omized , double-blind , placebo-controlled , parallel , and 8 mo long , and incorporated 6 mo of zinc supplementation .  Children ( n = 153 ) aged 55.8 + /- 11.2 mo from 3 r and omly selected nursery schools of medium , low , and very low socioeconomic status in a suburb of Kampala took part . The intervention comprised 10 mg Zn ( as ZnSO4 ) or placebo daily in freshly prepared fruit juice , Monday to Friday inclusive . RESULTS Zinc supplementation increased MUAC by the end of the study ( P = 0.029 ) and led to greater weight gain in children from the school of medium socioeconomic status at 3 and 8 mo ( P = 0.019 and P = 0.038 , respectively ) . There was no effect on weight gain of the children from the other schools . Zinc supplementation had no influence on height . Infection rates ( of which 82 % were recorded as malaria ) were lower in the zinc-supplemented group than in control subjects ( P = 0.063 ) . CONCLUSIONS Zinc supplementation may counter the age-related decrease in MUAC often observed in preschool children in developing countries . The study provides evidence that zinc may not be the most limiting nutrient for weight gain in children of poor nutritional status , but may become so as nutritional status improves Thirty-four malnourished children were rehabilitated on either a cow 's milk or a soya protein based formula diet . The soya diet contained 25 % less zinc than the cow 's milk diet and 1.33 mmol/l phytic acid . When the marasmic children were given either of these diets they had a dramatic fall in their plasma zinc concentration .  Children given the soya formula had an even more profound drop in plasma zinc , to levels associated with acrodermatitis enteropathica . Plasma zinc remained low throughout the phase of rapid weight gain , but rose when a mixed diet was given and the children ceased gaining weight . There was a negative correlation between the rate of weight gain and the plasma zinc concentration , the rate of new tissue synthesis being the predominant modulator of the plasma zinc concentration . The energy cost of tissue deposition was initially low on the cow 's milk diet and relatively high on the soya diet . Later , the energy costs rose in the cow 's milk fed children . The rate of weight gain was less on the soya diet ; however , the appetite , as measured by the ad libitum dietary intakes , did not differ between the diets , or correlate with the plasma zinc concentration . This may be due to the relatively low protein content of the diets used . It is concluded that dietary zinc may limit the rate of weight gain during periods of recovery in body mass and may be a cause for the excessive deposition of adipose tissue To determine whether zinc deficiency might be involved in the failure to thrive observed in undernourished Vietnamese children , we assessed growth , incidence of infections , and circulating insulin-like growth factor I ( IGF-I ) concentrations in a double-blind study of zinc supplementation .  Growth-retarded children ( n=146 ) aged 4 - 36 mo were paired according to age , sex , commune , Z scores for weight ( WAZ ) and for height ( HAZ ) , and number of siblings , and were r and omly assigned to receive either 153 micromol ( 10 mg ) Zn/d or a placebo for 5 mo . Weight , height , and episodes of infection were recorded each month and plasma IGF-I was measured 1 and 5 mo after the start of zinc supplementation . Multiple-linear-regression analysis for paired data showed that zinc supplementation increased weight ( + 0.5 + /- 0.1 kg ; P<0.001 ) and height ( + 1.5+/-0.2 cm ; P<0.001 ) after 5 mo compared with placebo treatment . The relative risk of infectious episodes in the zinc-treated subjects was reduced 3-fold for diarrhea ( P=0.012 ) and 2.5-fold for respiratory infections ( p=0.057 ) . The probability of having at least two episodes of diarrhea or respiratory infection was 2.9- and 3.2-fold lower , respectively , in zinc-treated subjects between 1 and 5 mo ( P=0.018 ) , whereas they did not change in placebo-treated subjects ( P-0.584 ) . After 1 mo , IGF-I concentration ( -x+/-SD ) in zinc-treated subjects was 2.8+/-0.3 nmol/L compared with 1.9+/-0.2 nmol/L in placebo-treated subjects ( P=0.021 ) . After 5 mo , the values were 3.4+/-0.5 nmol/L ( zinc-treated ) and 2.0+/-0.3 nmol/L ( placebo-treated ; P=0.044 ) . Our study suggests that zinc deficiency may limit growth in nutritionally deprived children . Because the increase in growth velocity result ing from zinc supplementation was associated with increased plasma IGF-I concentrations , we suggest that the growth-stimulating effect of zinc might be mediated through changes in circulating The exact mechanism whereby zinc influences growth is unknown , although it has been postulated that zinc may stimulate appetite and energy intake or enhance fat-free mass ( FFM ) accrual directly . We compared energy intake , reported appetite , and body composition of 6- to 8-mo-old Peruvian children with initial length-for-age Z-score ( LAZ ) < -0.5 SD who were r and omly assigned to receive daily for 6 mo : 1 )  3 mg/d zinc in a liquid supplement ; 2 )  3 mg/d zinc in a fortified porridge ; or 3 ) no extra zinc in either the supplement or porridge . There were no group-wise differences in changes in dietary energy intakes or body composition or in the prevalence of reported poor appetite . However , among children with an initial LAZ less than the median ( -1.1 SD ) , those who received zinc as a liquid supplement had a 0.41 kg greater increase in FFM than those who did not receive zinc ( P < 0.05 ) . We concluded that daily provision of 3 mg of supplemental zinc did not affect energy intake or reported appetite . Among children with initial mild-to-moderate stunting , those who received the zinc supplement had a greater increase in FFM than those who did not receive additional zinc . It is possible that the growth-restricted children were more likely to be zinc deficient and that FFM accrual may be an early growth response to supplemental zinc . Zinc supplements may be more efficacious than the same dose of zinc provided in fortified food ; therefore , further research is needed on the optimal level of zinc fortification that will result in improved health outcomes in population s with high rates of zinc deficiency The impact of zinc supplementation on the growth and body composition of Guatemalan infants was assessed in a community-based , double-blind intervention trial . Infants aged 6 - 9 mo were assigned r and omly to receive 4 mL of a beverage containing 10 mg of zinc as zinc sulfate ( n = 45 ) or a placebo ( n = 44 ) daily ( 7 d/wk ) for an average of 6.9 mo . The children 's weight , length , mid-upper arm and head circumferences , and triceps skinfolds were measured at baseline and at 1 - 2 mo intervals until the end of supplementation . Midarm muscle area ( MMA ) was derived from the mid-upper arm circumference and triceps skinfolds measurements . Maternal anthropometry and family socioeconomic and demographic characteristics also were obtained . Zinc supplementation was associated with an overall increase of 0.61 cm2 in MMA ( P = 0.02 ) . Children who received zinc supplements had a mean length increment that was 0.75 cm greater than those who did not ( P = 0.12 ) . However , there was a significant interaction between treatment group and initial length-for-age status ( P = 0.04 ) , such that supplemented children who were stunted at baseline ( length-for-age Z score less than -2 ) gained 1.40 cm more than stunted children who received the placebo . We conclude that zinc supplementation of these rural Guatemalan infants during 6 . 9 mo increased accretion of fat-free mass and enhanced the linear growth of those who were stunted at baseline . Further research is required to determine whether zinc supplementation during longer periods of time may achieve larger and more generalized effects on physical growth 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 BACKGROUND Leptin , ghrelin , and insulin are hormonal regulators of energy balance and , therefore , may be related to growth during infancy . Zinc is essential for growth , and its growth effects may be mediated through these hormones . OBJECTIVE We examined the effects of supplemental zinc on plasma leptin , ghrelin , and insulin concentrations among young children at risk of zinc deficiency and examined the relations between these hormones and physical growth . DESIGN Children ( n = 142 ) aged 6 - 8 mo were r and omly assigned to receive 3 mg Zn/d as a supplement , in a fortified food , or as a placebo for 6 mo . Relations between hormones and anthropometric z scores , body composition , and growth rates were examined at baseline and 3 and 6 mo after the start of the intervention . RESULTS No treatment group-related differences were found in plasma leptin , ghrelin , or glucose concentrations or in anthropometric z scores at 3 or 6 mo after the start of the zinc intervention . Neither plasma leptin nor ghrelin concentrations at baseline or 3 mo were predictive of subsequent changes in growth . However , changes in weight-for-age z scores over the two 3-mo time intervals were positively associated with subsequent leptin concentrations and inversely associated with subsequent plasma ghrelin concentrations . CONCLUSIONS Supplemental zinc did not affect the children 's  growth , anthropometric indexes , or plasma hormone concentrations in this study population . Our results suggest that plasma leptin and ghrelin concentrations in later infancy are a consequence of previous weight changes rather than predictors of short-term growth Background : Obese individuals are more likely to have either lower blood concentrations or lower bioavailability of minerals and /or vitamins . However , there are limited data on the effects of nutritional supplementation on body weight ( BW ) control , energy homeostasis and lipid metabolism in obese subjects . Objective : The purpose of this study is to evaluate the effects of supplementation with multivitamin and multimineral on adiposity , energy expenditure and lipid profiles in obese Chinese women . Design : A total of 96 obese Chinese women ( body mass index ( BMI ) 28 kg m−2 ) aged 18–55 years participated in a 26-week r and omized , double-blind , placebo-controlled intervention study . Subjects were r and omized into three groups , receiving either one tablet of multivitamin and mineral supplement ( MMS ) , or calcium 162 mg ( Calcium ) or identical placebo daily during the study period . BW , BMI , waist circumference ( WC ) , fat mass ( FM ) , fat-free mass , resting energy expenditure ( REE ) , respiratory quotient ( RQ ) , blood pressure , fasting plasma glucose and serum insulin , total cholesterol ( TC ) , low- and high-density lipoprotein-cholesterol ( LDL-C and HDL-C ) and triglycerides ( TGs ) were measured at baseline and 26 weeks . Results : A total of 87 subjects completed the study . After 26 weeks , compared with the placebo group , the MMS group had significantly lower BW , BMI , FM , TC and LDL-C , significantly higher REE and HDL-C , as well as a borderline significant trend of lower RQ ( P=0.053 ) and WC ( P=0.071 ) . The calcium group also had significantly higher HDL-C and lower LDL-C levels compared with the placebo group . Conclusion : The results suggest that , in obese individuals  , multivitamin and mineral supplementation could reduce BW and fatness and improve serum lipid profiles , possibly through increased energy expenditure and fat oxidation . Supplementation of calcium alone ( 162 mg per day ) only improved lipid profiles BACKGROUND Stunting is highly prevalent in Ethiopia and many other developing countries but the reason for it is poorly understood . Zinc is essential for growth but diets in such countries often do not contain zinc in sufficient quantity or of sufficient bioavailability . Thus zinc deficiency may play a major role in stunting . The aim of the study was to investigate whether the low rate of linear growth of apparently healthy breastfed infants in a rural village in Ethiopia could be improved by zinc supplementation . METHODS A r and omised , double-blind , placebo-controlled trial was done on apparently healthy breastfed infants aged 6 - 12 months . 100 non-stunted ( length-for-age , Z score < -2 ) were matched for age and sex with 100 r and omly selected stunted ( > -2 ) infants . Infants , both stunted and non stunted , were matched by sex , age ( within 2 months ) and recumbent length ( within 3 cm ) for r and om assignment , to receive a zinc supplement ( 10 mg zinc per day , as zinc sulphate ) or placebo , 6 days a week for 6 months . Anthropometric measurements were taken monthly , data on illness and appetite were collected daily , and sample s of serum and hair were taken at the end of the intervention for the analysis of zinc . FINDINGS The length of stunted infants increased significantly more ( p<0.001 ) when supplemented with zinc ( 7.0 cm [ SE 1.1 ] ) than with placebo ( 2.8 cm [ 0.9 ] ) ; and the effect was greater ( p<0.01 ) than in non-stunted infants ( 6.6 [ 0.9 ] vs 5.0 [ 0.8 ] cm for the zinc and placebo groups respectively , p<0.01 ) . Zinc supplementation also increased the weight of stunted children ( 1.73 [ 0.39 ] vs 0.95 [ 0.39 ] kg for the corresponding placebo group , p<0.001 ) and of non-stunted children ( 1.19 [ 0.39 ] vs 1.02 [ 0.32 ] kg for the corresponding placebo group , p<0.05 ) . Zinc supplementation result ed in a markedly lower incidence of anorexia and morbidity from cough , diarrhoea , fever , and vomiting in the stunted children . The total number of these conditions per child was 1.56 and 1.11 in the stunted and non-stunted zinc supplemented children versus 3.38 and 1.64 in the stunted and non-stunted placebo-treated children , respectively . At the end of the intervention period , the concentrations of zinc in serum and hair of stunted infants , who had not been supplemented with zinc , were lower than the respective concentrations of zinc in serum and hair of their non-stunted counterparts . INTERPRETATION Combating zinc deficiency can increase the growth rate of stunted children  to that of non-stunted infants in rural Ethiopia . This would appear to be due , at least in part , to reduction in morbidity from infection and increased appetite OBJECTIVES To analyse the effect of zinc supplementation in growth and nutritional status of a homogeneous group of newborns with intra uterine growth retardation and asymmetric growth . The effect of changes of zinc status on growth and leptin serum concentrations was also analysed . POPULATION AND METHODS A double blind , r and omised clinical trial was design ed in order to detect differences in growth between zinc and placebo groups during the first 6 months of life . 31 infants were included either to the zinc group ( n = 14 ) ( 38.8+/-1.4 weeks GA , 2,171+/-253 g body weight ) or the placebo group ( n = 17 ) ( 38.9+/-1.1 weeks GA , 2,249+/-220 g body weight ) . The zinc group received a supplement of 3 mg elemental zinc per day ( as zinc sulphate ) . RESULTS There were not significant differences between groups for anthropometric measurements through the study period . We found a significant effect of the study group , in hair zinc concentrations , but not in serum zinc concentrations ; post-hoc comparisons for hair zinc revealed that there were significant differences between groups at 1 , 2 , and 6 months of age . Changes in serum and hair zinc concentrations from baseline to 6 months , showed significant correlations with changes in weight/age and length/age z-scores , in the supplement group . Changes in leptin serum concentrations during follow-up , showed significant correlations with changes in sum of 4 skinfolds and weight/age z-score , in the placebo group . Changes in hair zinc concentration through the study period showed significant correlations with changes in leptin serum concentrations from baseline to 6 months of follow-up . CONCLUSIONS In a homogeneous group of intra uterine growth retardation infants with asymmetric growth , 3 mg/day zinc supplementation do not show significant improvements in weight and length growth . Changes in zinc status were related with changes in weight and length during the first 6 months of life . Changes in leptin serum concentrations were related with changes in the anthropometric indices of body fat accretion BACKGROUND Information is needed on the fractional absorption of zinc ( FAZ ) and absorbed zinc ( AZ ) during prolonged exposure to zinc-fortified foods . OBJECTIVE The objective was to measure FAZ and AZ from diets fortified with different amounts of zinc and to determine whether zinc absorption changes over approximately 7 wk . DESIGN Forty-one stunted , moderately anemic children received daily , at breakfast and lunch , 100 g wheat products fortified with 3 mg Fe ( ferrous sulfate ) and 0 ( group Zn-0 ) , 3 ( group Zn-3 ) , or 9 ( group Zn-9 ) mg Zn ( zinc sulfate ) per 100 g flour . FAZ was measured on days 2 - 3 and 51 - 52 ; meal-specific AZs were calculated as the product of FAZ and zinc intake . RESULTS For the breakfast and lunch meals combined , mean total zinc intakes were 2.14 , 4.72 , and 10.04 mg/d in groups Zn-0 , Zn-3 , and Zn-9 , respectively , during the initial absorption studies ; mean ( + /-SD ) FAZ values were 0.341 + /- 0.111 , 0.237 + /- 0.052 , and 0.133 + /- 0.041 , respectively , on days 2 - 3 ( P < 0.001 ) and did not change significantly on days 51 - 52 in the subset of 31 children studied twice . Mean initial AZ was positively related to zinc intake ( 0.71 + /- 0.18 , 1.11 + /- 0.21 , and 1.34 + /- 0.47 mg/d , respectively ; P < 0.001 ) ; final values did not differ significantly from the initial values . CONCLUSIONS AZ from meals containing zinc-fortified wheat products increases in young children relative to the level of fortification and changes only slightly during approximately 7-wk periods of consumption . Although consumption of zinc-fortified foods may reduce FAZ , zinc fortification at the levels studied positively affects total daily zinc absorption , even after nearly 2 mo of exposure to zinc-fortified diets The present study tested the hypothesis that inadequate Zn intake might be responsible for failure to thrive and impaired catch-up growth in young rural Gambian children , and that Zn supplements might be beneficial . Gambian children might be deprived of Zn because of its poor availability from their predominantly plant-based diet . Rural Gambian children ( 110 ; fifty boys , sixty girls ) aged between 0.57 and 2.30 years were divided into two matched groups , one to receive 70 mg Zn twice weekly for 1.25 years , and the other a placebo . Growth and mid-upper-arm circumference were measured at weekly intervals throughout the study and illnesses were monitored .  Capillary blood and urine sample s were collected at 0 , 2 and 8 weeks . Body weights and arm circumferences showed a linear increase , plus a seasonal effect ( rainy season faltering ) . For body weight there was no significant overall effect of the supplement . For arm circumference , a very small ( 2 % ) but significant ( P < 0.01 ) difference favoured the supplemented group . Plasma thymulin was much lower at the first clinic than at the second and third clinics , and in vitro Zn stimulation was greater at the first clinic . There was , however , no effect of Zn in vivo . Likewise , Zn did not significantly benefit T-cell numbers or ratios , secretory IgA in urine , circulating hormone levels or biochemical indices of Zn status . One index of intestinal permeability , i.e. lactulose : creatinine , was improved ( P < 0.02 ) by the supplement , but the lactulose : mannitol value was not ; this requires further investigation . Dietary Zn deficiency is , thus , unlikely to be of major overall importance for rural Gambian children 's ability to thrive , and blanket Zn supplementation is not justified . There may , however , be vulnerable sub-groups who would benefit from Zn supplements This cross-sectional study was conducted to determine the association of high body fat per cent measured by bioelectric impedance analysis with known risk factors of obesity as well as with serum levels of vitamins , trace elements and magnesium and oxidative stress in an urban population in India . There were 850 men aged 25 - 64 years , r and omly selected from the city of Moradabad . Subjects were divided into high body fat per cent ( n = 357 ) , over fat per cent ( n = 230 ) , desirable fat ( n = 200 ) and low fat ( n = 63 ) based on criteria of body fat per cent analysis . The prevalence of central obesity , sedentary lifestyle , family history and higher visible fat intake showed significant association with higher over fat per cent . Postpr and ial plasma insulin and glucose and serum iron and oxidative stress were significantly higher and plasma levels of vitamin C and E and serum zinc/insulin ratio as well as serum magnesium/insulin ratio showed inverse association with high body fat per cent . Multivariate logistic regression analysis after adjustment of age showed a significant positive association of body mass index ( odds ratio 0.97 ) , sedentary lifestyle ( odds ratio 1.12 ) and serum iron ( OR 1.00 ) with higher body fat per cent . Zinc ( OR 1.03 ) , magnesium ( OR 1.02 ) , vitamins C ( OR 1.08 and E ( OR 1.09 ) deficiency were risk factors of higher body per cent and central obesity . It is possible that some Indian men can benefit by increased intake of zinc , magnesium , vitamin C and vitamin E in conjunction with lifestyle changes Leptin is thought to be a lipostatic signal that contributes to body weight regulation . Zinc might play an important role in appetite regulation and its administration stimulates leptin production . However , there are few reports in the literature on its role on leptin levels in the obese population . The present work asseses the effect of zinc supplementation on serum leptin levels in insulin resistance ( IR ) . A prospect i ve double-blind , r and omized , clinical , placebo-controlled study was conducted . Fifty-six normal glucose-tolerant obese women ( age : 25–45 yr , body mass index [ BMI ] = 36.2 ±2.3 kg/m2 ) were r and omized for treatment with 30 mg zinc daily for 4 wk . Baseline values of both groups were similar for age , BMI , caloric intake , insulin concentration , insulin resistance , and zinc concentration in diet , plasma , urine , and erythrocytes . Insulin and leptin were measured by radioimmunoassay and IR was estimated by the homeostasis model assessment ( HOMA ) . The determinations of zinc in plasma , erythrocytes , and 24-h urine were performed by using atomic absorption spectrophotometry . After 4 wk , BMI , fasting glucose , and zinc concentration in plasma and erythrocyte did not change in either group , although zinc concentration in the urine increased from 385.9±259.3 to 470.2±241.2±μg/24 h in the group with zinc supplementation ( p<0.05 ) . Insulin did not change in the placebo group , whereas there was a significant decrease of this hormone in the supplemented group . HOMA also decreased from 5.8±2.6 to 4.3±1.7 ( p<0.05 ) in the zinc-supplemented group but did not change in the placebo group . Leptin did not change in the placebo group . In the zinc group , leptin was 23.6±12.3 μg/L and did not change . More human data from a unique population of obese individuals with documented insulin resistance would be useful in guiding future studies on zinc supplementation ( with higher doses or longer intervals ) or different measures OBJECTIVES : To assess the effect of zinc supplementation on growth and body composition among schoolchildren . DESIGN : R and omized , double-blind , placebo-controlled trial . SETTING AND SUBJECTS : 313 rural Zimbabwean schoolchildren ( 144 boys and 169 girls ) , 11–17 y ) . INTERVENTIONS : Supplementation with zinc ( 30 or 50 mg ) or placebo on schooldays for 12 months . Due to drought , a food programme was in operation during the last eight months of the study .VARIABLES : Weight , height , upper arm circumference , triceps skinfold thickness , and weight-for-age , height-for-age , weight-for-height , arm muscle-area-for-age and arm fat-area-for-age Z-scores . RESULTS : Significant effects on weight gain ( 0.51 vs 0.14 kg , P=0.01 ) , weight-for-age Z ( −0.08 vs −0.14 , P=0.01 ) and arm muscle area-for-age Z-score ( 0.10 vs 0.01 , P=0.03 ) were seen over the first three months , whereas no effects were seen over the full 12 months . CONCLUSIONS : Zinc deficiency impairing lean body mass and weight gain was documented . However , the effect of zinc seen over the first three months vanished during the last nine months when the food programme was in operation . Zinc deficiency may have persisted , but another nutrient may have become growth limiting during the last nine months . SPONSORSHIP : Danish International Development Assistance Serum  zinc and hair zinc concentrations of some New Zeal and children aged 11 yr , were examined in relation to selected anthropometric indices . Serum zinc concentrations ( n=453 ) in boys and girls were similar and were unrelated to anthropometric indices and hair zinc concentrations . Mean hair zinc concentration ( n=620 ) of the girls was higher than that for the boys ( 2.95±0.49 vs 2.46±0.47 µmol/g ; p<0.001 ) . Correlation analysis demonstrated that , for the boys , all the studied anthropometric indices , with the exception of height , were significantly related to hair zinc concentration and that the confounding effects of mid-parent height and the timing of the adolescent growth spurt was small . Results for the girls were similar but less significant . Dichotomizing the hair zinc results divided both the boys and girls into two groups : those with hair zinc < 2.44 µmol/g were heavier ( girls , 39.0 vs 35.2 kg ; boys , 36.6 vs 34.7 kg ) and fatter ( mid-upper-arm fat area : girls , 15.2 vs 12.0 cm2 ; boys , 11.1 vs 9.5 cm2 ) compared to their counterparts with hair zinc > 2.44 µmol/g . The results demonstrate that in these healthy New Zeal and children , those with lower hair zinc concentrations are fatter and heavier than their high-hair-zinc counterparts We assessed the effect of zinc supplementation on growth velocity in 79 children and adolescents ( 48 males , 38 females ) with idiopathic short stature . Their height‐for‐age was < 5th percentile ( NCHS st and ards ) and their weight‐for‐age was normal . Patients were assigned r and omly to a supplemented group ( S ) to receive Zn 10 mg/day or to a placebo ( P ) group , according to gender and age , and were followed‐up for 12 months using a double‐blind design . Weight , height , armspan , length of lower segment and plasma and hair concentrations of Zn were measured at 0 , 3 , 6 and 12 months . On admission and at 6 months , energy , protein , dietary fiber and zinc intakes were similar for groups S and P ; mean zinc intake was < 6.5mg/day . No differences were found in plasma zinc , hair zinc , weight . armspan or lower segment increments . Pre‐adolescent males in group S had a significantly greater increase in stature compared with group P ( 6.2 ± 2.1 versus 4.5 ± 1.2 cm/year p < 0.025 ) ; z score improved from —2.42 to —2.24 in group S and from — 2.63 to — 2.61 in group P. For adolescent males , the difference was also significant ( 8.3 ± 1.5 versus 6.2 & 2.1 cm/year ; p < 0.025 ) . No differences were noted in females . In Chilean male schoolchildren and adolescents with idiopathic short stature  , zinc supplementation increases growth velocity over a 12‐month period In rural Mexico and in many developing countries micronutrient deficiencies , growth stunting , and morbidity from infectious diseases are highly prevalent in young children . We assessed the extent to which growth stunting could be reversed and the number of infectious disease episodes reduced by zinc and /or iron supplementation . In a double-blind , r and omized community trial 219 Mexican preschoolers were supplemented with either 20 mg Zn as zinc methionine , 20 mg Fe as ferrous sulfate , 20 mg Zn + 20 mg Fe , or a placebo . After 12 mo , plasma zinc increased significantly in the two zinc-treated groups , and plasma ferritin was significantly higher in the two iron-treated groups . There was no effect of treatments on growth velocity or body composition . Children in both zinc-supplemented groups had fewer episodes of disease ( zinc alone , 3.9 + /- 0.3 ; zinc+iron , 3.7 + /- 0.4 ; placebo , 4.6 + /- 0.5 ; P < 0.03 ) , including diarrhea ( zinc alone , 0.7 + /- 0.1 ; zinc+iron , 0.8 + /- 0.1 ; placebo , 1.1 + /- 0.2 ; P < 0.01 ) . Zinc and zinc+iron supplements reduced morbidity but had no effect on growth or body composition OBJECTIVE The aim of our study was to evaluate the effect of zinc supplementation on linear growth , body composition , and growth factors in premature infants . DESIGN Thirty-six preterm infants ( gestational age : 32.0 + /- 2.1 weeks , birth weight : 1704 + /- 364 g ) participated in a longitudinal double-blind , r and omized clinical trial . They were r and omly allocated either to the supplemental ( S ) group fed with a st and ard term formula supplemented with zinc ( final content 10 mg/L ) and a small quantity of copper ( final content 0.6 mg/L ) , or to the placebo group fed with the same formula without supplementation ( final content of zinc : 5 mg/L and copper : 0.4 mg/L ) , from 36 weeks postconceptional age until 6 months corrected postnatal age  . At each evaluation , anthropometric variables and bioelectrical impedance were measured , a 3-day dietary record was collected , and a blood sample was taken . We analyzed serum levels of total alkaline phosphatase , skeletal alkaline phosphatase ( sALP ) , insulin growth factor (IGF)-I , IGF binding protein-3 , IGF binding protein-1 , zinc and copper , and the concentrations of zinc in erythrocytes . RESULTS The S group had significantly higher zinc levels in serum and erythrocytes and lower serum copper levels with respect to the placebo group . We found that the S group had a greater linear growth ( from baseline to 3 months corrected age : Delta score deviation st and ard length : 1.32 + /-.8 vs.38 + /-.8 ) . The increase in total body water and in serum levels of sALP was also significantly higher in the S group ( total body water : 3 months ; corrected age : 3.8 + /-.5 vs 3.5 + /-.4 kg , 6 months ; corrected age : 4.5 + /-.5 vs 4.2 + /-.4 kg ; sALP : 3 months ; corrected age : 140.2 + /- 28.7 vs 118.7 + /- 18.8 micro g/L ) . CONCLUSIONS Zinc supplementation has a positive effect on linear growth in premature infants The objective of this study was to determine whether zinc deficiency is one of the factors involved in nutritional failure to thrive in infants and toddlers . Participants were selected on the basis of anthropometric criteria , particularly a decline in weight velocity preceding changes in length gains . The investigation was design ed as a double-blind , r and omized , pair-matched , controlled study of dietary zinc supplementation of 6 months ' duration . Anthropometric data were collected at 0 , 1 , 3 , and 6 months . Twenty-five pairs of infants completed the project . When compared with placebo-treated control children , the zinc-supplemented group ( combined sexes ) and the supplemented boys showed significant improvements in st and ard deviation scores for weight for all three intervals , the largest differences occurring for the 0- to 3-month interval ( P less than or equal to .0001 ) . The zinc-supplemented girls demonstrated a trend toward improvements in changes in st and ard deviation scores for weight ( P = .056 ) . There were no differences in length gains for either boys or girls . This improvement in weight gains after zinc supplementation demonstrates that mild zinc deficiency can be one of the etiologic factors in nutritional failure to thrive during infancy
target: Zn supplementation was associated with increased fat-free mass among stunted children .
  Due to the use of anthropometry when determining body composition , a majority of the studies could not accurately address whether alterations in the fat and /or fat-free mass components of the body were responsible for the observed changes in body composition .
  The effect of Zn supplementation on body composition is not consistent but may modify fat-free mass among children with pre-existing growth failure
background: OBJECTIVE To provide a comprehensive synthesis of the effects of Zn supplementation on childhood body composition and adiposity-related hormone levels .