Additional zinc delivered in a liquid supplement, but not in a fortified porridge, increased fat-free mass accrual among young Peruvian children with mild-to-moderate stunting.

The exact mechanism whereby zinc influences growth is unknown, although it has been postulated that zinc may stimulate appetite and energy intake or enhance fat-free mass (FFM) accrual directly. We compared energy intake, reported appetite, and body composition of 6- to 8-mo-old Peruvian children with initial length-for-age Z-score (LAZ) < -0.5 SD who were randomly assigned to receive daily for 6 mo: 1) 3 mg/d zinc in a liquid supplement; 2) 3 mg/d zinc in a fortified porridge; or 3) no extra zinc in either the supplement or porridge. There were no group-wise differences in changes in dietary energy intakes or body composition or in the prevalence of reported poor appetite. However, among children with an initial LAZ less than the median (-1.1 SD), those who received zinc as a liquid supplement had a 0.41 kg greater increase in FFM than those who did not receive zinc (P < 0.05). We concluded that daily provision of 3 mg of supplemental zinc did not affect energy intake or reported appetite. Among children with initial mild-to-moderate stunting, those who received the zinc supplement had a greater increase in FFM than those who did not receive additional zinc. It is possible that the growth-restricted children were more likely to be zinc deficient and that FFM accrual may be an early growth response to supplemental zinc. Zinc supplements may be more efficacious than the same dose of zinc provided in fortified food; therefore, further research is needed on the optimal level of zinc fortification that will result in improved health outcomes in populations with high rates of zinc deficiency.