A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein-energy malnutrition in Lesotho. II: Special investigations.

Protein-energy malnutrition (PEM) remains one of the common causes of morbidity and mortality among children throughout the world. The supplementation of 10 mg elemental zinc, as zinc sulphate, was evaluated in the management of PEM in a randomized, controlled, double-blind clinical trial in 300 children, aged 6-60 months (zinc, n = 150; control, n = 150) admitted to the Queen Elizabeth II Hospital, Maseru, Lesotho. Supplementation and follow-up were done for 3 months post-discharge from the hospital. Both the supplemented and the control groups presented with biochemically determined zinc deficiency on presentation. Despite supplementation the treated group only began to show evidence of biochemical increase in serum zinc at 60 days post-discharge from hospital. This may represent the period of replacement of the total body zinc. Zinc deficiency was more severe in those children in the control group that died after admission to hospital than those that survived, suggesting that low serum levels in children with PEM are associated with a poor prognosis. Zinc did not emerge as a predicator of poor prognosis in the supplemented group as very few children died in this group. The supplemented group also made significant gains as far as albumin levels were concerned, which probably reflects rehabilitation of their malnutrition. The associated improvement in haematological parameters has not been described before and may be secondary to the decreased burden of disease in the supplemented group. These findings suggest that not only were significant benefits of zinc supplementation shown for morbidity in mortality of children in Lesotho with PEM, but these trends were also demonstrated on biochemical profiles.