Zinc for diarrhea - Pediatric diarrhea

Zinc in nutrition > Nutrition for premature babies > Zinc deficiency signs and symptoms

Childhood diarrhea (pediatric diarrhea) is the major cause of morbidity, undernourishment and mortality in newborns, infants, toddlers and children in developing countries.

WHO (World Health Organisation) estimated that more than 1.87 million children below the age of five years died in the year 2003 due to pediatric diarrhea. Though many microbial causes of diarrhea have been discovered, the resultant dehydration is the main cause of mortality.

Role of zinc in treatment of pediatric diarrhea

Zinc is being assessed for more than twenty years for efficacy in treatment of pediatric diarrhea. Most of the studies have proved its usefulness as adjunct to ORS (oral rehydration solution) in treatment of acute diarrhea and reduction in its severity and duration. However it is to be noted that ORS remains the mainstay of diarrhea therapy as the rehydration is the top most priority. Zinc gives the added benefits of reduced stool volume, reduced stool frequency and reduced duration of the episode. Further, this trace mineral has been found to reduce the recurrent incidences of pediatric diarrhea in treated patients. WHO recommends that, in addition to reduced osmolarity ORS,  zinc at the rate of 10-20 mg/day be given for 10 - 14 days for all children suffering from diarrhea.
Sadly, there is very slow progress in implementation of these revised guidelines by the world nations.
For example, although the Government of India, under the National Rural Health Mission, has provided for low osmolarity ORS and zinc through the public health system, a UNICEF survey in India documented less than 1% zinc prescriptions for pediatric diarrhea.
The main reason is lack of awareness about the efficacy and cost-effectiveness in these diarrhea treatment methods, even among the health care providers.

Reduced low osmolarity WHO-ORS

WHO is its latest recommendations has advised oral rehydration therapy (ORT) with ORS developed for global use in pediatric diarrhea. This improved hypotonic WHO-ORS is more effective and has lower osmolarity with reduced sodium and glucose concentrations. In comparison with earlier standard ORS, there is less vomiting, less stool output and reduced need for intravenous infusions on using this reduced osmolarity ORS.
Oral rehydration solution (ORS) constituents - Composition by weight

Reduced osmolarity ORS	grams/liter
Sodium chloride	2.6
Glucose, anhydrous	13.5
Potassium chloride	1.5
Trisodium citrate, dihydrate	2.9

Oral rehydration solution (ORS) constituents - Composition by molar concentrations

Reduced osmolarity ORS	mmol/litre
Sodium	75
Chloride	65
Glucose, anhydrous	75
Potassium	20
Citrate	10
Total Osmolarity	245

Mechanism of Action of zinc in Pediatric diarrhea

It is a well known fact that this trace mineral is required in many metabolic activities in the human body.
It is a critical component of many metallo-enzymes and mediates in gene transcription.
It has a central role in cellular and immune functions.
It is found to improve the absorption water and electrolytes.
As it improves the cell division and cell growth, it has positive effects on the repair and regeneration of intestinal epithelium.
Brush border is the microvilli covered surface of small intestine and has enzymes  helping absorption. This trace mineral helps in the production of these brush border enzymes.
By the immunity enhancing activity of this trace mineral, the pathogens responsible for diarrhea are resisted and there is better clearance of these harmful organisms from the digestive tract.

Thus many studies evaluating the efficacy of zinc supplementation have established that it has a preventive, protective and lasting impact on pediatric diarrhea.

Related topics:
Zinc health benefits
Food sources
Signs and symptoms of deficiency
Role in immunity
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