role of zinc in diahorrea


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role of zinc in diahorrea pneumonia and as a gen immunity booster

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role of zinc in diahorrea

  2. 2. Introduction <ul><li>Acute gastroenteritis : a very common illness among infants and children throughout world. </li></ul><ul><li>In India poor sanitation, lack of safe drinking water, overcrowding & poverty are factors that make diarrheal disorders more frequent. </li></ul>
  3. 3. Diarrhea: Definition <ul><li>Stool weight > 250 gm each day: impractical. </li></ul><ul><li>Hence, working definition of diarrhea includes: -- ↑ stool frequency (>2-3 motions per day ) or -- Passage of loose , unformed stools. </li></ul>
  4. 4. Acute diarrhea <ul><li>Occurrence of 3 or more unformed (loose) stools per day, for fewer than 14 days. </li></ul><ul><li>Acute diarrhea accounts for 35 %, dysentery for another 20 % of total diarrheal deaths. </li></ul>
  5. 5. Childhood diarrhea: Rx <ul><li>Oral rehydration supplements (O.R.S.): corrects dehydration </li></ul><ul><li>Antibiotics : Combat bacterial infection </li></ul><ul><li>Probiotics : Useful non-pathogenic bacteria which compete with harmful bacteria in intestine & inhibit their growth . E.g. Lactobacilli </li></ul><ul><li>Anti-hypersecretory: Racecadotril (Trotz) </li></ul><ul><li>Nutritional supplements like zinc which boost immunity . </li></ul>
  6. 6. Role of Zinc in health & disease <ul><li>Immune booster : Zinc deficiency rapidly ↓ antibody- & cell-mediated immune responses. Short periods of zinc supplementation substantially improve immune defense. </li></ul><ul><li>Anti-oxidant function : Superoxide radicals reduced to hydrogen peroxide by superoxide dismutases in presence of zinc co-factors. Efficient removal of these superoxide free radicals maintains integrity of membranes, ↓ risk of cancer, & slows aging process. </li></ul><ul><li>Growth : Zinc deficiency limits growth in young children & has been shown to affect fetal growth in animal models. In infants that were born small for gestational age (SGA ) or preterm, positive effect of zinc supplementation on growth was shown. </li></ul>
  7. 7. Zinc & Immunity <ul><li>Studies have shown that Zn deficiency rapidly antibody- & cell-mediated responses in both humans & animals. </li></ul><ul><li>Moderate deficiencies in Zn occur in sickle cell anemia, renal disease, chronic gastrointestinal disorders & acrodermatitis enteropathica; HIV; children with diarrhea; & elderly persons. </li></ul><ul><li>Such Zn deficiency greatly alters host defense systems, leading to in in opportunistic infections & mortality rates. </li></ul><ul><li>Conversely, short periods of Zn supplementation substantially improve immune defense in individuals with these diseases. </li></ul>
  8. 8. Zinc & Immunity <ul><li>Data from animal studies clearly demonstrate that immune integrity is tightly linked to Zn status. </li></ul><ul><li>Lymphopenia & thymic atrophy - early hallmarks of Zn deficiency – are due to high losses of precursor T & B cells in the bone marrow. </li></ul><ul><li>Glucocorticoid-mediated apoptosis induced by Zn deficiency causes down-regulation of lymphopoiesis . </li></ul><ul><li>Zn itself can modulate death processes in precursor lymphocytes. </li></ul><ul><li>Evidence show that Zn supplementation may impact of many of the diseases mentioned above by preventing dismantling of immune system. </li></ul>
  9. 10. Zinc and Diarrhea <ul><li>Significant ↓ in both tissue & serum Zn common in acute and chronic diarrhea. </li></ul><ul><li>Zinc depletion occurs in diarrhea, more so in chronic state. </li></ul><ul><li>Significant negative correlation between serum zinc & diarrheal duration . </li></ul><ul><li>In a study, mean serum and tissue zinc levels in children with acute and chronic diarrhea were found to be significantly lower than healthy and infected controls. </li></ul><ul><li>Zinc supplements have been shown to have a beneficial effect on acute diarrhea in children. </li></ul><ul><li>It is reported that zinc supplementation leads to accelerated regeneration of intestinal mucosa, ↑ levels of brush-border enzymes, ↑ cellular immunity & ↑ levels of secretory antibodies. </li></ul>
  10. 11. Features of zinc deficiency <ul><li>Dermatitis </li></ul><ul><li>Alopecia </li></ul><ul><li>Diarrhea </li></ul><ul><li>Dwarfism </li></ul><ul><li>Hypogonadism </li></ul><ul><li>Low growth rates </li></ul><ul><li>Hypogeusia. (Taste disturbance) </li></ul>
  11. 12. Effects of Zinc supplementation <ul><li>Improving Zn status ↓ morbidity from diarrheal & respiratory infection . </li></ul><ul><li>Zinc supplementation leads to: </li></ul><ul><li>Accelerated regeneration of mucosa </li></ul><ul><li>Increased levels of brush-border enzymes </li></ul><ul><li>Enhanced cellular immunity </li></ul><ul><li>Higher levels of secretory antibodies. </li></ul><ul><li>In stunted children, Zn supplementation results in enhanced catch-up growth via higher levels of insulin-like growth factor-I (IGF-1) </li></ul>
  12. 13. Zn supplements: Diarrhea & infections <ul><li>Zinc an adjunctive Rx </li></ul><ul><li>Not a replacement to important Rxs like ORS in AD. </li></ul><ul><li>Zn supplements in children useful in: </li></ul><ul><li>Dietary intake low in absorbable zinc </li></ul><ul><li>Severe stunting </li></ul><ul><li>Low plasma zinc </li></ul><ul><li>Persistent diarrhea . </li></ul><ul><li>Inadequate Zn intakes highly prevalent in developing countries, especially during period of complementary feeding when Zn requirements are high & breast milk contributes little. </li></ul>
  13. 14. Zinc supplement in diarrhea & infections <ul><li>RCTs show that </li></ul><ul><li>Zn-supplemented children had lower rates of diarrhea, pneumonia & malaria compared to children not given Zn. </li></ul><ul><li>Zn used as an adjunct to fluid & dietary management of AD & PD found to ↓ diarrheal duration & severity </li></ul><ul><li>Hence, Zn supplement useful as preventive & therapeutic intervention in developing countries as zinc deficiency is prevalent. </li></ul>
  14. 15. Acta Paediatr. 2003 May;92(5):531-6.
  15. 18. Arch Dis Child. 1997 Sep;77(3):196-200.
  16. 19. Arch Dis Child. 1997 Sep; 77(3):196-200 25% reduction in time to recovery
  17. 20. Arch Dis Child. 1997 Sep;77(3):196-200 400% increase in wt. gain
  18. 21. Lancet 2005; 366 (9490):999-1004
  19. 22. Lancet 2005; 366 (9490):999-1004
  20. 23. Lancet 2005; 366 (9490):999-1004
  21. 24. Lancet 2005; 366 (9490):999-1004
  22. 25. Pediatrics 2003 Dec;112(6 Pt 1):1327-32
  23. 26. Thank You