Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.
Nutrients. 2013 Nov 21;5(11):4715-40. doi: 10.3390/nu5114715.
Evidence supporting the impact of therapeutic zinc supplementation on the duration and severity of diarrhea among children under five is largely derived from studies conducted in South Asia. China experiences a substantial portion of the global burden of diarrhea, but the impact of zinc treatment among children under five has not been well documented by previously published systematic reviews on the topic. We therefore conducted a systematic literature review, which included an exhaustive search of the Chinese literature, in an effort to update previously published estimates of the effect of therapeutic zinc. We conducted systematic literature searches in various databases, including the China National Knowledge Infrastructure (CNKI), and abstracted relevant data from studies meeting our inclusion and exclusion criteria. We used STATA 12.0 to pool select outcomes and to generate estimates of percentage difference and relative risk comparing outcomes between zinc and control groups. We identified 89 Chinese and 15 non-Chinese studies for the review, including studies in 10 countries from all WHO geographic regions, and analyzed a total of 18,822 diarrhea cases (9469 zinc and 9353 control). None of the included Chinese studies had previously been included in published pooled effect estimates. Chinese and non-Chinese studies reported the effect of therapeutic zinc supplementation on decreased episode duration, stool output, stool frequency, hospitalization duration and proportion of episodes lasting beyond three and seven days. Pooling Chinese and non-Chinese studies yielded an overall 26% (95% CI: 20%-32%) reduction in the estimated relative risk of diarrhea lasting beyond three days among zinc-treated children. Studies conducted in and outside China report reductions in morbidity as a result of oral therapeutic zinc supplementation for acute diarrhea among children under five years of age. The WHO recommendation for zinc treatment of diarrhea episodes should be supported in all low- and middle-income countries.
支持治疗性补锌对 5 岁以下儿童腹泻持续时间和严重程度影响的证据主要来自南亚的研究。中国在全球腹泻负担中占有相当大的比例，但之前关于该主题的系统评价并没有很好地记录锌治疗对 5 岁以下儿童的影响。因此，我们进行了一项系统的文献综述，其中包括对中文文献的详尽搜索，以努力更新之前发表的关于治疗性锌作用的估计。我们在多个数据库中进行了系统的文献搜索，包括中国国家知识基础设施（CNKI），并从符合我们纳入和排除标准的研究中提取相关数据。我们使用 STATA 12.0 汇总选择的结果，并生成比较锌组和对照组结果的百分比差异和相对风险的估计值。我们确定了 89 篇中文和 15 篇非中文研究进行综述，包括来自所有世卫组织地理区域的 10 个国家的研究，并分析了总共 18822 例腹泻病例（9469 例锌和 9353 例对照）。纳入的中文研究均未被之前发表的汇总效果估计所包含。中文和非中文研究报告了治疗性补锌对缩短腹泻发作持续时间、粪便排出量、粪便频率、住院时间以及持续超过 3 天和 7 天的腹泻发作比例的影响。汇总中文和非中文研究得出，锌治疗组腹泻持续时间超过 3 天的相对风险总体降低 26%（95%CI：20%-32%）。在中国和国外进行的研究报告称，口服治疗性锌补充剂可降低 5 岁以下儿童急性腹泻的发病率。所有低收入和中等收入国家都应支持世卫组织关于锌治疗腹泻发作的建议。
