Role of Zinc in Anti-Diarrheal Therapy in Childhood Diarrhea Samyek Napit

Roll no. 66NAIHS-COM

• World Health Organization(WHO) and United Nations Children’s Emergency Fund recommends that all children with acute diarrheal illness should be treated with Zinc, “regardless of etiology”.

Zinc reduces severity, duration and recurrence in ensuing 2-3 months.

For children <6 months of age

10 mg Zinc for 10-14 days should be given daily

For children >6 months of age up to 5 yrs

20 mg Zinc for 10-14 days daily

• Zinc tablets are available in the following forms :-

Zinc Sulfate

Zinc Acetate

Zinc Gluconate

Role of Zinc Zinc is an important micro-nutrient.

Over 300 biological functions, functioning of more than 100 enzymesMother’s milk provides the required 2mg of zn

Age Group Recommended Dietary Allowance

0-6 months 2 mg

7-12 months 3 mg

1-3 yrs 3 mg

4-8 yrs 5 mg

9-13 yrs 8 mg

14-18 yrs 11 mg(m) 9 mg(f)

19+ 11 mg(m)

Role of Zinc

• for protein synthesis, cell growth and differentiation• immune function• maintaining cell membrane integrity (Bettger and

Odell 1993).• intestinal transport of fluid and electrolyte??• is component of enzymes like carbonic anhydrase,

alcohol dehydrogenase, etc

Zinc Deficiency

• Zinc deficiency is a common among children in underdeveloped and developing countries.

Causeso Low intake of diet rich in Zinc

o Lack of breast-feeding

o Excess intake of legumes and whole grains- rich in phytates which inhibit Zinc absorption (among vegetarians)

Causes..

o Chronic Diarrhoea

o Malabsorbtion

o Other Gastrointestinal diseases

Effects of Zinc deficiency• impaired immune function

• diarrhea

• growth retardation

• Impairment of sexual development

• loss of appetite

• eye and skin lesions

• Weight loss

• delayed healing of wounds

• taste abnormalities/ impairment in development of taste buds (gustin)

• mental lethargy

Effect of Zinc deficiency on immune system

• rapid and extensive effect

• promotes production of glucocorticoids from adrenal gland acting via hypothalamus and pituitary

• glucocorticoid mediated apoptosis

• results in loss of precursor lymphocytes( less bcl2 gene expression)

• down regulation of Lymphopoiesis

• loss in antibody mediated response

How does Zinc help in diarrhoea?• Zinc supplementation +

ORS stops diarrhoea faster *

• Prevent reoccurrence of diarrhoea in the following months

• Prevents aforementioned problems due to Zinc deficiency

*Clear beneficial effects seen among infants > 6 months

Applicable in both acute and Chronic diarrhea

Mechanism

•Zinc inhibits cAMP induced, chlorine dependent fluid secretion

•Zinc inhibits basolateral K+ channels

•Boosts the immune system

•Increases the absorption of water and electrolytes????

• Inhibits toxin induced cholera

• As an adjunct to antimicrobial (AM) treatment in bloody dysentery showed increase in the bactericidal antibody titers against Shigella

• Increases the levels of brush border enzymes

• Increases intestinal epithelium regeneration

Cost of Management

• Also, studies have shown that the use of Zinc therapy reduces the overall cost of management of diarrhea

• Make ORS therapy more cost-effective

FOR 10-14 DAYS!

• http://www.youtube.com/watch?v=8cpzCPtZwoU

References• “Effectiveness of zinc supplementation plus oral rehydration salts

for diarrhoea in infants aged less than 6 months in Haryana state” by Sarmila Mazumder a, Sunita Taneja a, Nita Bhandari a, Brinda Dube a, RC Agarwal b, Dilip Mahalanabis c, Olivier Fontaine d & Robert E Black e

Bulletin of the World Health Organization 2010;88:754-760. doi: 10.2471/BLT.10.075986

• The Dynamic Link between the Integrity of the Immune System and Zinc Status by Pamela J. Fraker, Louis E. King, Tonya Laako, Teresa L. Vollmer (American Society for Nutritional Sciences)

• Role of Zinc in pediatric diarrhea- Indian Journal of Pharmacology

Thank You!