Edwards Jeffrey G, Dhingra Pratibha, Liu Enju, Dhingra Usha, Dutta Arup, Sudfeld Christopher R, Deb Saikat, Somji Sarah, Aboud Said, Kisenge Rodrick, Sazawal Sunil, Ashorn Per, Simon Jonathan, Manji Karim P, Duggan Christopher P
Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Center for Public Health Kinetics, New Delhi, India.
J Pediatr Gastroenterol Nutr. 2025 Apr;80(4):598-610. doi: 10.1002/jpn3.12441. Epub 2025 Jan 13.
Supplemental zinc during acute diarrhea reduces illness duration but also increases vomiting. In a recent trial, we found that children receiving lower daily doses of zinc (5 mg or 10 mg vs. 20 mg) had lower rates of vomiting with comparable stool output and duration of diarrhea. We performed a secondary analysis to identify sociodemographic and clinical factors associated with vomiting in children with acute diarrhea.
We performed a secondary data analysis of 4500 children aged 6-59 months with an acute episode of diarrhea (<72 h before enrollment) in a randomized, double-blind controlled trial in India and Tanzania. To identify clinically important risk factors for overall, regimen-related, and regimen-unrelated vomiting, we created log-binomial models with relative risks (RRs) and 95% confidence intervals (CIs).
The trial enrolled 4500 children, of whom 1203 (26.7%) had any vomiting. After adjusting for multiple demographic and clinical characteristics, the presence of dehydration (RR: 1.45, 95% CI: 1.10-1.92), being underweight (RR: 1.22, 95% CI: 1.05-1.41), receipt of the rotavirus vaccine (RR: 1.89, 95% CI: 1.69-2.12), and household wealth above the median (RR: 1.17, 95% CI: 1.07-1.29) were factors associated with an increased risk of vomiting. Rotavirus vaccine receipt was nearly 100% concordant with the study site of Tanzania. Older age and lower zinc dosing were associated with a lower risk of vomiting.
Young, underweight, or dehydrated children are more likely to have concurrent vomiting with zinc supplementation. Identification of these factors may allow providers to better monitor such children, thus reducing the chances of recurrent dehydration or inadequate dietary intake.
急性腹泻期间补充锌可缩短病程，但也会增加呕吐发生率。在最近一项试验中，我们发现每日接受较低剂量锌（5毫克或10毫克，对比20毫克）的儿童呕吐发生率较低，且粪便排出量和腹泻持续时间相当。我们进行了一项二次分析，以确定与急性腹泻儿童呕吐相关的社会人口统计学和临床因素。
我们对印度和坦桑尼亚一项随机双盲对照试验中4500名6至59个月大的急性腹泻发作儿童（入组前腹泻<72小时）进行了二次数据分析。为了确定总体、方案相关和方案无关呕吐的临床重要危险因素，我们创建了具有相对风险（RR）和95%置信区间（CI）的对数二项式模型。
该试验纳入了4500名儿童，其中1203名（26.7%）出现过呕吐。在调整了多种人口统计学和临床特征后，脱水（RR：1.45，95%CI：1.10-1.92）、体重不足（RR：1.22，95%CI：1.05-1.41）、接种轮状病毒疫苗（RR：1.89，95%CI：1.69-2.12）以及家庭财富高于中位数（RR：1.17，95%CI：1.07-1.29）是与呕吐风险增加相关的因素。接种轮状病毒疫苗的情况与坦桑尼亚的研究地点几乎100%一致。年龄较大和锌剂量较低与呕吐风险较低相关。
年幼、体重不足或脱水的儿童在补充锌时更有可能同时出现呕吐。识别这些因素可能使医护人员能够更好地监测此类儿童，从而减少反复脱水或饮食摄入不足的可能性。
