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role of zinc in diahorrea

role of zinc in diahorrea



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

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



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    role of zinc in diahorrea role of zinc in diahorrea Presentation Transcript

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