Zinc supplementation for acute and persistent watery diarrhoea in children: A systematic review and meta-analysis.

IF 4.5 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Ayesha Arshad Ali, Syeda Kanza Naqvi, Zain Hasnain, Mustafa Bin Ali Zubairi, Ashraf Sharif, Rehana Abdus Salam, Sajid Soofi, Shabina Ariff, Yasir Bin Nisar, Jai K Das
{"title":"Zinc supplementation for acute and persistent watery diarrhoea in children: A systematic review and meta-analysis.","authors":"Ayesha Arshad Ali, Syeda Kanza Naqvi, Zain Hasnain, Mustafa Bin Ali Zubairi, Ashraf Sharif, Rehana Abdus Salam, Sajid Soofi, Shabina Ariff, Yasir Bin Nisar, Jai K Das","doi":"10.7189/jogh.14.04212","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Zinc is a micronutrient that plays a role in immune system strengthening and regulation of intestinal epithelial cells, and can reduce the duration and severity of diarrhoea. We conducted a systematic review of randomised controlled trials (RCTs) to assess the effectiveness of zinc compared to no zinc for the management of acute and persistent diarrhoea in children.</p><p><strong>Methods: </strong>We searched PubMed, the Cochrane Library, Scopus, CINAHL, ClinicalTrials.gov, and World Health Organization (WHO) International Clinical Trials Registry Platform from inception until 31 July 2023 for studies published from year 2000 onwards that assessed the use of zinc in the management of acute and persistent diarrhoea in children aged less than 10 years. We conducted the meta-analysis in Cochrane's RevMan software, determined risk of bias in individual studies using the Risk of Bias 2 (RoB 2) tool, and assessed the quality of evidence through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This review was commissioned by the WHO for revision of their guidelines for childhood diarrhoea management.</p><p><strong>Results: </strong>We included 38 RCTs in this systematic review. Our findings suggest that, in children with acute diarrhoea, zinc supplementation resulted in a greater proportion of children who recovered from diarrhoea at last follow-up (risk ratio (RR) = 1.07; 95% confidence interval (CI) = 1.03, 1.1; moderate certainty of evidence) and a reduction in the duration of diarrhoea (mean difference (MD) = -13.27 hours; 95% CI = -17.66, -8.89; moderate certainty of evidence) when compared to placebo. A significant number of children in the zinc group compared to placebo experienced vomiting (RR = 1.46; 95% CI = 1.22, 1.76; moderate certainty of evidence), however, there were few vomiting episodes in low-dose zinc group compared to high-dose (RR = 0.80; 95% CI = 0.72, 0.89; moderate certainty of evidence). In children with persistent diarrhoea, zinc supplementation led to a greater proportion of children who recovered from diarrhoea (RR = 1.75; 95% CI = 1.34, 2.30; low certainty of evidence). The low certainty of evidence ratings were mostly due to high heterogeneity among the studies.</p><p><strong>Conclusions: </strong>Zinc should continue to be recommended in children under the age of 10 years with acute or persistent diarrhoea, but moderate certainty of evidence concludes that the dose of zinc should be reduced. However, further multi-country randomised clinical trials are required with a direct comparison to assess the appropriate dosage, duration and adverse effects.</p><p><strong>Registration: </strong>PROSPERO: CRD42023439028.</p>","PeriodicalId":48734,"journal":{"name":"Journal of Global Health","volume":"14 ","pages":"04212"},"PeriodicalIF":4.5000,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622351/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Global Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7189/jogh.14.04212","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Zinc is a micronutrient that plays a role in immune system strengthening and regulation of intestinal epithelial cells, and can reduce the duration and severity of diarrhoea. We conducted a systematic review of randomised controlled trials (RCTs) to assess the effectiveness of zinc compared to no zinc for the management of acute and persistent diarrhoea in children.

Methods: We searched PubMed, the Cochrane Library, Scopus, CINAHL, ClinicalTrials.gov, and World Health Organization (WHO) International Clinical Trials Registry Platform from inception until 31 July 2023 for studies published from year 2000 onwards that assessed the use of zinc in the management of acute and persistent diarrhoea in children aged less than 10 years. We conducted the meta-analysis in Cochrane's RevMan software, determined risk of bias in individual studies using the Risk of Bias 2 (RoB 2) tool, and assessed the quality of evidence through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This review was commissioned by the WHO for revision of their guidelines for childhood diarrhoea management.

Results: We included 38 RCTs in this systematic review. Our findings suggest that, in children with acute diarrhoea, zinc supplementation resulted in a greater proportion of children who recovered from diarrhoea at last follow-up (risk ratio (RR) = 1.07; 95% confidence interval (CI) = 1.03, 1.1; moderate certainty of evidence) and a reduction in the duration of diarrhoea (mean difference (MD) = -13.27 hours; 95% CI = -17.66, -8.89; moderate certainty of evidence) when compared to placebo. A significant number of children in the zinc group compared to placebo experienced vomiting (RR = 1.46; 95% CI = 1.22, 1.76; moderate certainty of evidence), however, there were few vomiting episodes in low-dose zinc group compared to high-dose (RR = 0.80; 95% CI = 0.72, 0.89; moderate certainty of evidence). In children with persistent diarrhoea, zinc supplementation led to a greater proportion of children who recovered from diarrhoea (RR = 1.75; 95% CI = 1.34, 2.30; low certainty of evidence). The low certainty of evidence ratings were mostly due to high heterogeneity among the studies.

Conclusions: Zinc should continue to be recommended in children under the age of 10 years with acute or persistent diarrhoea, but moderate certainty of evidence concludes that the dose of zinc should be reduced. However, further multi-country randomised clinical trials are required with a direct comparison to assess the appropriate dosage, duration and adverse effects.

Registration: PROSPERO: CRD42023439028.

补充锌治疗儿童急性和持续性水样腹泻:一项系统综述和荟萃分析。
背景:锌是一种微量营养素,在增强免疫系统和调节肠上皮细胞中发挥作用,可以缩短腹泻的持续时间和严重程度。我们进行了一项随机对照试验(RCTs)的系统回顾,以评估锌与无锌治疗儿童急性和持续性腹泻的有效性。方法:我们检索了PubMed、Cochrane图书馆、Scopus、CINAHL、ClinicalTrials.gov和世界卫生组织(WHO)国际临床试验注册平台,从2000年开始到2023年7月31日,检索了自2000年以来发表的评估锌在10岁以下儿童急性和持续性腹泻治疗中的应用的研究。我们在Cochrane的RevMan软件中进行了meta分析,使用risk of bias 2 (RoB 2)工具确定了个别研究的偏倚风险,并通过分级推荐评估、发展和评价(GRADE)方法评估了证据的质量。这项审查是世卫组织为修订其儿童腹泻管理指南而委托进行的。结果:我们纳入了38项随机对照试验。我们的研究结果表明,在患有急性腹泻的儿童中,锌补充剂导致在最后一次随访中腹泻恢复的儿童比例更高(风险比(RR) = 1.07;95%置信区间(CI) = 1.03, 1.1;中度证据确定性)和腹泻持续时间缩短(平均差值(MD) = -13.27小时;95% ci = -17.66, -8.89;中度证据确定性)与安慰剂相比。与安慰剂组相比,锌组有大量儿童出现呕吐(RR = 1.46;95% ci = 1.22, 1.76;中度证据确定性),然而,与高剂量组相比,低剂量锌组呕吐事件较少(RR = 0.80;95% ci = 0.72, 0.89;证据的中等确定性)。在持续腹泻的儿童中,锌补充剂导致腹泻恢复的儿童比例更高(RR = 1.75;95% ci = 1.34, 2.30;证据的低确定性)。证据评级的低确定性主要是由于研究之间的高度异质性。结论:对于10岁以下患有急性或持续性腹泻的儿童,应继续推荐锌,但有中等确定性的证据表明,锌的剂量应该减少。然而,需要进一步的多国随机临床试验来直接比较,以评估适当的剂量、持续时间和不良反应。注册:普洛斯彼罗:CRD42023439028。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Global Health
Journal of Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -
CiteScore
6.10
自引率
2.80%
发文量
240
审稿时长
6 weeks
期刊介绍: Journal of Global Health is a peer-reviewed journal published by the Edinburgh University Global Health Society, a not-for-profit organization registered in the UK. We publish editorials, news, viewpoints, original research and review articles in two issues per year.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信