Zinc-Fortified Oral Rehydration Solution Improved Intestinal Permeability and Small Intestinal Mucosal Recovery

A randomized double-blind placebo-controlled study was conducted in children admitted to hospital with gastroenteritis (≥3 loose stools per day). All were treated for 5 days following admission with either zinc (Zn, 3 mg) or without Zn-fortified rice-based oral rehydration solution (ORS). 13C-sucrose breath test (SBT) and intestinal permeability (lactulose/rhamnose or L/R ratio) were performed concurrently prior to commencement of ORS with or without Zn and at day 5 post-admission. There was a significant improvement in the SBT results in both the Zn-fortified group, median (5th-95th percentile) 2.1% (0.4% to 8.3%) versus 4.4% (0.4% to 10.4%), P < .05, and control group, 1.4% (0.1% to 5.4%) versus 4.3% (0.4% to 11.4%), P < .05, between the day of admission and day 5 post-admission. In the Zn-fortified group, there was also a significant improvement in L/R ratio between the day of admission and day 5 post-admission, 53.0 (19.5-90.6) versus 17.7 (13.4-83.2), P < .05. Low levels of Zn improved intestinal permeability but did not enhance short-term recovery following diarrheal illness.

[1]  G. Hussey,et al.  Review of rotavirus studies in Africa: 1976-2006. , 2010, The Journal of infectious diseases.

[2]  R. Glass,et al.  The epidemiology of rotavirus diarrhea in countries in the Eastern Mediterranean Region. , 2010, The Journal of infectious diseases.

[3]  M. Mekawy,et al.  Bee honey added to the oral rehydration solution in treatment of gastroenteritis in infants and children. , 2010, Journal of medicinal food.

[4]  G. Davidson,et al.  Efficacy of Lactobacillus GG in Aboriginal Children With Acute Diarrhoeal Disease: A Randomised Clinical Trial , 2010, Journal of pediatric gastroenterology and nutrition.

[5]  M. Dibley,et al.  Therapeutic Value of Zinc Supplementation in Acute and Persistent Diarrhea: A Systematic Review , 2010, PloS one.

[6]  Robert E Black,et al.  The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality , 2010, International journal of epidemiology.

[7]  C. F. Fischer Walker,et al.  Zinc and low osmolarity oral rehydration salts for diarrhoea: a renewed call to action. , 2009, Bulletin of the World Health Organization.

[8]  G. Davidson,et al.  13C-Sucrose Breath Test: Novel Use of a Noninvasive Biomarker of Environmental Gut Health , 2009, Pediatrics.

[9]  K. Brown,et al.  Preventive Zinc Supplementation among Infants, Preschoolers, and Older Prepubertal Children , 2009, Food and nutrition bulletin.

[10]  Kenji Shibuya,et al.  Estimating child mortality due to diarrhoea in developing countries. , 2008, Bulletin of the World Health Organization.

[11]  N. Zavaleta,et al.  Efficacy of Rice-based Oral Rehydration Solution Containing Recombinant Human Lactoferrin and Lysozyme in Peruvian Children With Acute Diarrhea , 2007, Journal of pediatric gastroenterology and nutrition.

[12]  R. Playford,et al.  Zinc carnosine, a health food supplement that stabilises small bowel integrity and stimulates gut repair processes , 2006, Gut.

[13]  J. Dziura,et al.  Amylase-Resistant Starch as Adjunct to Oral Rehydration Therapy in Children with Diarrhea , 2006, Journal of pediatric gastroenterology and nutrition.

[14]  G. Davidson,et al.  A novel breath test for the Non‐invasive assessment of small intestinal mucosal injury following methotrexate administration in the rat , 2004, Scandinavian journal of gastroenterology.

[15]  P. Coyle,et al.  Dietary supplementation with zinc and a growth factor extract derived from bovine cheese whey improves methotrexate-damaged rat intestine. , 2003, The American journal of clinical nutrition.

[16]  V. Curtis Talking dirty: how to save a million lives , 2003, International journal of environmental health research.

[17]  D. Brewster,et al.  Small Bowel Intestinal Permeability in Australian Aboriginal Children , 2002, Journal of pediatric gastroenterology and nutrition.

[18]  S. Sarker,et al.  Reduced osmolarity oral rehydration solution for persistent diarrhea in infants: a randomized controlled clinical trial. , 2001, The Journal of pediatrics.

[19]  S. Long Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries : Pooled analysis of randomized controlled trials , 2001 .

[20]  R. Martorell,et al.  Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. , 2000, The American journal of clinical nutrition.

[21]  A. Bari,et al.  Bangladeshi rural mothers prepare safer rice oral rehydration solution , 2000, Acta paediatrica.

[22]  D. Brewster,et al.  Dual sugar permeability testing in diarrheal disease. , 2000, The Journal of pediatrics.

[23]  R Martorell,et al.  Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group. , 1999, The Journal of pediatrics.

[24]  A S Prasad,et al.  Zinc and immune function: the biological basis of altered resistance to infection. , 1998, The American journal of clinical nutrition.

[25]  G. Cleghorn,et al.  A controlled trial comparing the efficacy of rice‐based and hypotonic glucose oral rehydration solutions in infants and young children with gastroenteritis , 1997, Journal of gastroenterology and hepatology.

[26]  S. Roy,et al.  Impact of Zinc Supplementation on Intestinal Permeability in Bangladeshi Children with Acute Diarrhoea and Persistent Diarrhoea Syndrome , 1992, Journal of pediatric gastroenterology and nutrition.

[27]  S. Gore,et al.  Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. , 1992, BMJ.

[28]  R. Uauy,et al.  Trace mineral balance during acute diarrhea in infants. , 1988, The Journal of pediatrics.

[29]  Klein Pd,et al.  Applications of stable isotopes to pediatric nutrition and gastroenterology: measurement of nutrient absorption and digestion using 13C. , 1985 .

[30]  P. Klein,et al.  Applications of Stable Isotopes to Pediatric Nutrition and Gastroenterology: Measurement of Nutrient Absorption and Digestion Using 13C , 1985, Journal of pediatric gastroenterology and nutrition.