The Nutritional Shield for Diarrhea

Acute diarrhea is a global threat to children below 5 years of age with nearly 1.5 million children dying every year due to childhood diarrhea and malnutrition. World Health Organization (WHO) suggests the use of low osmolarity ORT along with zinc salts to decrease the duration and intensity of acute diarrheal episodes. Zinc helps in repairing the gut lining, reduces fluid loss, and improves nutrient absorption. Thus, it aids in faster recovery of children and strengthens immunity.¹

In case of pediatric population, apart from Zinc supplementation and ORT some other nutrients like Selenium, Vitamin A, Vitamin D and MCT Oil supplementation are known to have positive outcomes on diarrhea. ^{2 3 4 5}

Role of Zinc in Diarrhea Management ¹

A) How Zinc Helps

•  Maintains a good immune system and intestinal integrity
•  Zinc is vital for cellular growth and differentiation which are important during recovery from infection.

B) Benefits of Zinc Supplementation in Diarrhea

•  Reduction in stool frequency, duration and stool volume
•  Long-term prevention: fewer recurrences of diarrhea even after 2–3 months of supplementation
•  Helps to replenish the zinc stores lost on account of diarrhea, thereby preventing deficiency which could worsen diarrhea.

Study Reviews:

Review -1 (2011 Bajait C e.al. India) ¹

Aim: To study the benefits of Zinc supplementation along with ORT in pediatric diarrhea and its beneficial effects on disease outcome.

Participants: Children 6 m - 5 years of age

Intervention: 20 mg elemental zinc + ORT (Oral Rehydration Therapy) for 10-14 days daily

Results: Zinc supplementation reduced duration and severity of diarrhea and lowered the recurrence in following two to three months.

Review 2(2000- Bhutta.et.al- Zinc Investigators' Collaborative (ZINC) Group) ⁶

Aim: To study the therapeutic benefits of zinc supplementation in pediatric population during recovery from diarrhea.

Participants: Children from developing countries below 5 years of age with acute or persistent diarrhea, data collected from multiple RCTs

Intervention: Oral Zinc supplementation with control groups receiving placebo or combinations of Vitamin A, B, C, D and E

Results: Zinc supplementation reduced severity of diarrheal episodes and mortality and proved to be more beneficial in cases of persistent diarrhea

Zinc supplementation acts as adjuvant therapy for both acute and persistent pediatric diarrhea. It has been proven to improve child health outcomes, reduced mortality associated with diarrheal disease.

References

¹ Bajait C, Thawani V. Role of zinc in pediatric diarrhea. Indian J Pharmacol. 2011;43(3):232-235. doi:10.4103/0253-7613.81495

² Sinaga, M., Supriatmo, Evalina, R., Yudiyanto, A. R., & Sinuha, A. B. (2016). Selenium for acute watery diarrhea in children. Paediatrica Indonesiana, 56(3), 151–156.

³ Tanchoco CC, Cruz AJ, Rogaccion JM, Casem RS, Rodriguez MP, Orense CL, Hermosura LC. Diet supplemented with MCT oil in the management of childhood diarrhea. Asia Pac J Clin Nutr. 2007;16(2):286-292.

⁴ Lazarus G, Putra IGNS, Junaidi MC, Oswari JS, Oswari H. The relationship of vitamin D deficiency and childhood diarrhea: a systematic review and meta-analysis. BMC Pediatr. 2024;24(1):125. Published 2024 Feb 16. doi:10.1186/s12887-024-04599-0

⁵ Long KZ, Estrada-Garcia T, Rosado JL, et al. The effect of vitamin A supplementation on the intestinal immune response in Mexican children is modified by pathogen infections and diarrhea. J Nutr. 2006;136(5):1365-1370. doi:10.1093/jn/136.5.1365

⁶ Zinc Investigators’ Collaborative Group (Bhutta ZA, Bird SM, Black RE, et al). Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr. 2000;72(6):1516–1522.

RTE Teaser

Only 24% children in India receive ORS + Zinc for diarrhea recovery.

To know how zinc supplementation can improve recovery from diarrhea click here.

Reference: Halli SS, Biradar RA, Prasad JB. Oral rehydration therapy and Zinc treatment among diarrhoeal children in India: Exploration from latest cross-sectional National Family Health Survey. PLoS One. 2024;19(10):e0307657. Published 2024 Oct 3.doi:10.1371/journal.pone.0307657