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Interventions and public health nutrition

Beneficial effects of zinc supplementation on head circumference of Nepalese infants and toddlers: a randomized controlled trial

European Journal of Clinical Nutrition volume 66, pages 836–842 (2012)Cite this article

Subjects

Abstract

Background/objective:

To assess the effects of micronutrient supplementation on head circumference of rural Nepali infants and children.

Subjects/methods:

We used a randomized controlled trial to assess the effects of micronutrient supplementation on head circumference in 569 rural Nepali infants and children aged 4–17 months. Children were randomized to: (1) zinc, (2) iron–folic acid, (3) zinc plus iron–folic acid or (4) a placebo group. Data on head circumference were collected during five visits at ∼3 month intervals over the course of a year. We calculated change in head circumference in treatment groups receiving zinc and iron comparing the first and fifth visits as well as used generalized estimating equations (GEE) to take advantage of data from all points in time. Models were adjusted for covariates unbalanced in the randomization and for baseline head circumference.

Results:

Estimating differences in head circumference between baseline and visit 5, children in the zinc treatment group showed smaller decreases in head circumference z-score compared with placebo (adjusted β=0.13, 95% confidence interval (CI): 0.03 to 0.23). Using GEE, zinc treatment was associated with 0.11 (95% CI: 0.05 to 0.17) decrease in the rate of decline in head circumference z-score across visits as compared with placebo. Iron–folic acid supplementation was not associated with head circumference z-scores when comparing visits 1 with 5 or including data across all visits in adjusted models.

Conclusion:

Our results suggest that zinc supplementation confers a beneficial effect on the rate of head growth in Nepali infants.

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Acknowledgements

The authors would like to thank Shivani Patel for her contribution to the statistical analyses. Support for this study was received from grants by the National Institutes of Health, Bethesda, MD, USA (HD 38753), the Bill and Melinda Gates Foundation, Seattle, WA, USA (810-2054) and a Cooperative Agreement between Johns Hopkins University and the Office of Health and Nutrition, US Agency for International Development, Washington, DC, USA (HRN-A-00-97-00015-00).

Funding: The study sponsors did not have a role in study design, data collection, analysis, interpretation or the writing of this report.

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Authors and Affiliations

  1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    P J Surkan, M Shankar, J Katz, E H Siegel, S C LeClerq, S K Khatry & J M Tielsch

  2. Nepal Nutrition Intervention Project-Sarlahi (NNIP-S), Sarlahi, Nepal

    S C LeClerq & S K Khatry

  3. Division of Nutritional Sciences, Program in International Nutrition, Cornell University, Ithaca, NY, USA

    R J Stoltzfus

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  1. P J Surkan
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  2. M Shankar
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Correspondence to P J Surkan.

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Surkan, P., Shankar, M., Katz, J. et al. Beneficial effects of zinc supplementation on head circumference of Nepalese infants and toddlers: a randomized controlled trial. Eur J Clin Nutr 66, 836–842 (2012). https://doi.org/10.1038/ejcn.2012.42

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  • DOI: https://doi.org/10.1038/ejcn.2012.42

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