Efficacy of highly bioavailable zinc from fortified water: a randomized controlled trial in rural Beninese children.
- Galetti V Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland; valeria.galetti@hest.ethz.ch.
- Kujinga P Division of Human Nutrition, Wageningen University, Wageningen, Netherlands;
- Mitchikpè CE Laboratory of Human Nutrition, Faculty of Agricultural Sciences, Abomey-Calavi University, Cotonou, Benin;
- Zeder C Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland;
- Tay F Clinical Trials Center, Center for Clinical Research, University Hospital of Zurich, Zurich, Switzerland; and.
- Tossou F Natitingou Health Zone, Ministry of Health, Natitingou, Benin.
- Hounhouigan JD Laboratory of Human Nutrition, Faculty of Agricultural Sciences, Abomey-Calavi University, Cotonou, Benin;
- Zimmermann MB Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland;
- Moretti D Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland;
- 2015-10-16
Published in:
- The American journal of clinical nutrition. - 2015
Benin
school-age children
water fortification
zinc absorption
zinc fortification
Adult
Benin
Child
Child Nutritional Physiological Phenomena
Cross-Over Studies
Deficiency Diseases
Diarrhea
Double-Blind Method
Drinking Water
Food, Fortified
Humans
Intestinal Absorption
Longitudinal Studies
Plasma
Prevalence
Rural Health
Single-Blind Method
Switzerland
Ultrafiltration
Urine
Zinc
Zinc Isotopes
English
BACKGROUND
Zinc deficiency and contaminated water are major contributors to diarrhea in developing countries. Food fortification with zinc has not shown clear benefits, possibly because of low zinc absorption from inhibitory food matrices. We used a novel point-of-use water ultrafiltration device configured with glass zinc plates to produce zinc-fortified, potable water.
OBJECTIVE
The objective was to determine zinc bioavailability from filtered water and the efficacy of zinc-fortified water in improving zinc status.
DESIGN
In a crossover balanced study, we measured fractional zinc absorption (FAZ) from the zinc-fortified water in 18 healthy Swiss adults using zinc stable isotopes and compared it with zinc-fortified maize porridge. We conducted a 20-wk double-blind randomized controlled trial (RCT) in 277 Beninese school children from rural settings who were randomly assigned to receive a daily portion of zinc-fortified filtered water delivering 2.8 mg Zn (Zn+filter), nonfortified filtered water (Filter), or nonfortified nonfiltered water (Pump) from the local improved supply, acting as the control group. The main outcome was plasma zinc concentration (PZn), and the 3 groups were compared by using mixed-effects models. Secondary outcomes were prevalence of zinc deficiency, diarrhea prevalence, and growth.
RESULTS
Geometric mean (-SD, +SD) FAZ was 7-fold higher from fortified water (65.9%; 42.2, 102.4) than from fortified maize (9.1%; 6.0, 13.7; P < 0.001). In the RCT, a significant time-by-treatment effect on PZn (P = 0.026) and on zinc deficiency (P = 0.032) was found; PZn in the Zn+filter group was significantly higher than in the Filter (P = 0.006) and Pump (P = 0.025) groups. We detected no effect on diarrhea or growth, but our study did not have the duration and power to detect such effects.
CONCLUSIONS
Consumption of filtered water fortified with a low dose of highly bioavailable zinc is an effective intervention in children from rural African settings. Large community-based trials are needed to assess the effectiveness of zinc-fortified filtered water on diarrhea and growth. These trials were registered at clinicaltrials.gov as NCT01636583 and NCT01790321.
Zinc deficiency and contaminated water are major contributors to diarrhea in developing countries. Food fortification with zinc has not shown clear benefits, possibly because of low zinc absorption from inhibitory food matrices. We used a novel point-of-use water ultrafiltration device configured with glass zinc plates to produce zinc-fortified, potable water.
OBJECTIVE
The objective was to determine zinc bioavailability from filtered water and the efficacy of zinc-fortified water in improving zinc status.
DESIGN
In a crossover balanced study, we measured fractional zinc absorption (FAZ) from the zinc-fortified water in 18 healthy Swiss adults using zinc stable isotopes and compared it with zinc-fortified maize porridge. We conducted a 20-wk double-blind randomized controlled trial (RCT) in 277 Beninese school children from rural settings who were randomly assigned to receive a daily portion of zinc-fortified filtered water delivering 2.8 mg Zn (Zn+filter), nonfortified filtered water (Filter), or nonfortified nonfiltered water (Pump) from the local improved supply, acting as the control group. The main outcome was plasma zinc concentration (PZn), and the 3 groups were compared by using mixed-effects models. Secondary outcomes were prevalence of zinc deficiency, diarrhea prevalence, and growth.
RESULTS
Geometric mean (-SD, +SD) FAZ was 7-fold higher from fortified water (65.9%; 42.2, 102.4) than from fortified maize (9.1%; 6.0, 13.7; P < 0.001). In the RCT, a significant time-by-treatment effect on PZn (P = 0.026) and on zinc deficiency (P = 0.032) was found; PZn in the Zn+filter group was significantly higher than in the Filter (P = 0.006) and Pump (P = 0.025) groups. We detected no effect on diarrhea or growth, but our study did not have the duration and power to detect such effects.
CONCLUSIONS
Consumption of filtered water fortified with a low dose of highly bioavailable zinc is an effective intervention in children from rural African settings. Large community-based trials are needed to assess the effectiveness of zinc-fortified filtered water on diarrhea and growth. These trials were registered at clinicaltrials.gov as NCT01636583 and NCT01790321.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.3945/ajcn.115.117028
- PMID 26468121
- Persistent URL
- https://folia.unifr.ch/global/documents/217614
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