Delivery of Iron and Zinc Supplements: Evaluation of Interaction Effect on Biochemical and Clinical Outcomes

Phase 4

Completed

• Conditions: Anemia; Diarrhea; Iron
• Interventions: Dietary Supplement: Zinc; Dietary Supplement: placebo; Dietary Supplement: iron and zinc on separate days; Dietary Supplement: iron and zinc combined; Dietary Supplement: iron

• Registration Number: NCT00470158
• Lead Sponsor: Johns Hopkins Bloomberg School of Public Health

Brief Summary

With the long-term public health goal of developing an effective micronutrient supplementation program to improve child health by improving iron and zinc status and decreasing morbidity due to diarrhea in areas with high rates of childhood malnutrition, we seek to determine the most efficacious method of decreasing childhood morbidity and mortality due to diarrhea in toddlers by re-examining the issue of iron and zinc interaction and determining if this interaction can be minimized by separate administration of iron and zinc supplementation.

Detailed Description

Iron supplementation is used in reducing anemia and improving hemoglobin status. Zinc supplementation is emerging as possibly an efficacious preventive measure in decreasing incidence of severe diarrhea. Previous studies have suggested interactions of zinc and iron when given together, reducing the effects of supplementation with both minerals. One study in Peru has shown a decrease in interaction effect with separate supplementation of iron and zinc in time when compared to iron administration alone or placebo; however, an evaluation of clinical outcomes and zinc or iron status when iron and zinc are administered separately compared to supplementation of zinc and iron together or each alone has not previously been done. This trial will assess the effect of iron and zinc supplementation given on alternate days compared with giving them together in a combined supplement.

We propose a randomized, double blind, placebo-controlled community trial of children 6-23 months in Mirzapur, Bangladesh. We will recruit and enroll 1000 children 6-23 months old who are permanent residents of the selected villages. Each child will be randomly assigned to 1) daily alternating zinc and placebo 2) daily alternating iron/folic acid and placebo 3) daily alternating zinc/iron/folic acid and placebo 4) daily alternating zinc and iron/folic acid 5) daily placebo. Primary outcomes will include incidence of severe diarrhea, evaluated weekly for 6 months, hemoglobin, prevalence of anemia, and serum zinc.

Analysis of the data will be done to compare the effect of separate iron and zinc supplementation as compared to combined iron and zinc supplementation as well as compared to iron, zinc, or placebo single supplementation. We will evaluate the difference in incidence rate of severe diarrhea, serum hemoglobin, percent anemia, and serum zinc. Since this will be a randomized, double-blind, placebo controlled trial, differences in effect will be most likely explained by the timing of supplement doses. If there is an improvement in clinical and biochemical outcomes, this would be consistent with a decreased interaction of absorption. If no difference is found, there may be another mechanism for the seeming interaction of iron and zinc besides that of mutually inhibitory absorption in the intestine.

Study Timeline

• Study Start: 2007-05
• Study First Submitted: 2007-05-03
• Study First Submitted QC: 2007-05-03
• Study First Posted: 2007-05-07
• Primary Completion: 2008-02
• Study Completion: 2008-02
• Status Verified: 2009-12
• Results First Submitted: 2011-08-10
• Results First Submitted QC: 2011-08-10
• Results First Posted: 2011-09-19
• Last Update Submitted: 2018-04-18
• Last Update Posted: 2018-04-20

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1000

Inclusion Criteria

• Children 6-18 months old
• Permanent residents of the selected villages

Exclusion Criteria

• Severe malnutrition requiring hospitalization (defined as weight for height <-3 SD Z-score)
• Severe anemia requiring treatment (hemoglobin < 70 g/L)
• Chronic illness that would impair feeding ability
• Likely to move in next 6 months.
• Fever greater than 38.5
• Regular iron supplementation

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
zinc alone	Zinc	Zinc
placebo	placebo	-
Separate iron and zinc	iron and zinc on separate days	Iron and zinc on separate days
combined iron and zinc	iron and zinc combined	Iron and zinc together
iron alone	iron	Iron

Primary Outcome Measures

Name	Time	Method
Incidence of Diarrhea	6 months	A diarrhea episode was defined as three or more loose, liquid, or watery stools for 2 consecutive days, separated in time from an earlier or subsequent episode by at least 2 consecutive diarrhea-free days.

Secondary Outcome Measures

Name	Time	Method
Change in Hemoglobin	6 months
Percent Anemic	6 months
Change in Zinc Status	6 months

Trial Locations

Locations (1)

ICDDR,B; 🇧🇩 Dhaka, Mohakhali, Bangladesh