Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T03:35:02.540Z Has data issue: false hasContentIssue false
  • English
  • Français

Zinc: the missing link in combating micronutrient malnutrition in developing countries

Published online by Cambridge University Press:  07 March 2007

Rosalind S. Gibson
Rosalind S. Gibson*
Affiliation:
Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
*
Corresponding author: Professor R. S. Gibson, fax +64 3 479 7958, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The first cases of human Zn deficiency were described in the 1960s in the Middle East. Nevertheless, it was not until 2002 that Zn deficiency was included as a major risk factor in the global burden of disease, and only in 2004 did WHO/UNICEF include Zn supplements in the treatment of acute diarrhoea. Despite this recognition Zn is still not included in the UN micronutrient priority list, an omission that will continue to hinder efforts to reduce child and maternal mortality, combat HIV/AIDS, malaria and other diseases and achieve the UN Millennium Development Goals for improved nutrition in developing countries. Reasons for this omission include a lack of awareness of the importance of Zn in human nutrition, paucity of Zn and phytate food composition values and difficulties in identifying Zn deficiency. Major factors associated with the aetiology of Zn deficiency include dietary inadequacies, disease states inducing excessive losses or impairing utilization and physiological states increasing Zn requirements. To categorize countries according to likely risk of Zn deficiency the International Zinc Nutrition Consultative Group has developed indirect indicators based on the adequacy of Zn in the national food supplies and/or prevalence of childhood growth stunting. For countries identified as at risk confirmation is required through direct measurements of dietary Zn intake and/or serum Zn in a representative sample. Finally, in at risk countries either national or targeted Zn interventions such as supplementation, fortification, dietary diversification or modification, or biofortification should be implemented, where appropriate, by incorporating them into pre-existing micronutrient intervention programmes.

Keywords

ZincDeficiencyMicronutrientMalnutritionDeveloping countries
Type
The Rank Prize Lecture
Information
Proceedings of the Nutrition Society , Volume 65 , Issue 1 , February 2006 , pp. 51 - 60
Copyright
Copyright © The Nutrition Society 2006

References

Abrams, SA, Mushi, A, Hilmers, DC, Griffin, IJ, Davila, P, Allen, L (2003) A multinutrient-fortified beverage enhances the nutritional status of children in Botswana. Journal of Nutrition 133 1834–1840.Google Scholar
Adams, CL, Hambidge, M, Raboy, V, Dorsch, JA, Sian, L, Westcott, JL, Krebs, NF (2002) Zinc absorption from a low-phytic acid maize. American Journal of Clinical Nutrition 76 556–559.CrossRefGoogle ScholarPubMed
Aggett, PJ & Harries, JT (1979) Current status of zinc in health and disease states. Archives of Disease in Childhood 54 909–917.Google Scholar
Alloway, BJ (2004) Zinc in Soils and Crop Nutrition. Brussels, Belgium: International Zinc Association.Google Scholar
Ash, DM, Frongillo, EA, Ndosi, GD, Latham, M & Garcia, OP (2003) Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania. American Journal of Clinical Nutrition 77 891–898.CrossRefGoogle ScholarPubMed
Baqui, A, Black, RE, Arifeen, SEI, Yunus, MN, Chakraborty, J, Ahmed, S & Vaughan, JP (2002) Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial. British Medical Journal 325 1059–1066.CrossRefGoogle ScholarPubMed
Bates, CJ, Evans, PH, Dardenne, M, Prentice, A, Lunn, PG, Northrop-Clewes, CA et al. (1993) A trial of zinc supplementation in young rural Gambian children. British Journal of Nutrition 69 243–255.Google Scholar
Bentley, ME, Caulfield, LE, Ram, M, Santizo, MC, Hurtado, E, Rivera, JA, Ruel, MT & Brown, KH (1997) Zinc supplementation affects the activity patterns of rural Guatemalan infants. Journal of Nutrition 27 1333–1338.CrossRefGoogle Scholar
Bhutta, ZA, Black, RE, Brown, KH, Gardner, JM, Gore, S, Hidayat, A et al. (1999) Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group. Journal of Pediatrics 135 689–697.CrossRefGoogle ScholarPubMed
Bindra, GS, Gibson, RS, Thompson, LU (1986) [Phytate]:[calcium]/[zinc] ratios in Asian immigrant lacto-ovo vegetarian diets and their relationship to zinc nutriture. Nutrition Research 6 475–483.CrossRefGoogle Scholar
Brinch-Pedersen, H, Sorensen, LD, Holm, PB (2002) Engineering crop plants: getting a handle on phosphate. Trends in Plant Science 7 118–125.Google Scholar
Brooks, WA, Yunus, M, Santosham, M, Wahed, MA, Nahar, K, Yeasmin, S & Black, RE (2004) Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial. Lancet 363 1683–1688.CrossRefGoogle ScholarPubMed
Brown, KH, Peerson, JM, Rivera, J & Allen, LH (2002) Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition 75 1062–1071.Google Scholar
Castillo-Duran, C, Rodriguez, A, Venegas, G, Alvarez, P, Icaza, G (1995) Zinc supplementation and growth of infants born small for gestational age. Journal of Pediatrics 127 206–211.Google Scholar
Castillo-Duran, C, Vial, P, Uauy, R (1988) Trace mineral balance during acute diarrhea in infants. Journal of Pediatrics 113 452–457.CrossRefGoogle ScholarPubMed
Ciliberto, MA, Sandige, H, Ndekha, M, Ashorn, P, Briend, A, Cilierto, H & Manary, MJ (2005) Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial. American Journal of Clinical Nutrition 81 864–870.CrossRefGoogle ScholarPubMed
Coudray, C, Bousset, C, Pépin, D, Tressol, JC, Belanger, LF & Rayssiguier, Y (1998) Effect of acute ingestion of polyphenol compounds on zinc and copper absorption in the rat: utilisation of stable isotopes and ICP/MS technique. In Polyphenols in Food, pp. 173–177 [Amadó, R, Andersson, H, Bardòcz, S and Serra, F, editors]. Luxembourg: Office for Official Publications of the European Communities.Google Scholar
Davidsson, L, Almgren, A, Sandström, B, Juillerat, M-A & Hurrell, RF (1996) Zinc absorption in adult humans: the effects of protein sources added to liquid test meals. British Journal of Nutrition 75 607–613.Google Scholar
Davidsson, L, Ziegler, EE, Kastenmayer, P, van Dael, P, Barclay, D (2004) Dephytinisation of soyabean protein isolate with low native phytic acid content has limited impact on mineral and trace element absorption in healthy infants. British Journal of Nutrition 91 287–293.CrossRefGoogle ScholarPubMed
Egli, I, Davidsson, L, Zeder, C, Walczyk, T, Hurrell, R (2004) Dephytinization of a complementary food based on wheat and soy increases zinc, but not copper, apparent absorption in adults. Journal of Nutrition 134 1077–1080.CrossRefGoogle Scholar
Erdman, JW & Pneros-Schneier, AG (1994) Factors affecting nutritive value in processed foods. In Nutrition in Health and Disease, pp. 1569–1578 [Shils, ME, Olson, JA and Shile, M, editors]. Philadelphia, PA: Lea & Febiger.Google Scholar
Ezzati, M, Loez, AD, Rodgers, A, Vander Hoorn, S & Murray, CJL (2002) Selected major risk factors and global and regional burden of disease. Lancet 360 1347–1360.CrossRefGoogle ScholarPubMed
Ferguson, EL, Gibson, RS, Opare-Obisaw, C, Ounpuu, S & Lamba, C (1995) Dietary strategies for improving the zinc nutriture of rural Southern Malawian and Ghanaian children. Ecology of Food and Nutrition 34 33–47.Google Scholar
Ferguson, EL, Gibson, RS, Opare-Obisaw, C, Ounpuu, S, Thompson, LU & Lehrfeld, J (1993) The zinc nutriture of preschool children living in two African countries. Journal of Nutrition 123 1487–1496.CrossRefGoogle ScholarPubMed
Fitzgerald, SL, Gibson, RS, Quan de Serrano, J, Portovcsttrro, L, Vasquewz, A, de Zepeda, E, Lopez-Palacios, CY, Thompson, LU, Stephen, AM, Solomons, NW (1993) Trace element intakes and dietary phytate/Zn and Ca x phytate/Zn millimolar ratios of periurban Guatemalan women during the third trimester of pregnancy. American Journal of Clinical Nutrition 57 195–201.CrossRefGoogle ScholarPubMed
Friel, JK, Andrews, WL, Matthew, JD, Long, DR, Cornel, AM, Cox, M, McKim, E & Zerbe, GO (1993) Zinc supplementation in very-low-birthweight infants. Journal of Pediatric Gastroenterology and Nutrition 17 97–104.Google Scholar
Frossard, E, Bucher, M, Mächler, F, Mozafar, A, Hurrell, R (2000) Potential for increasing the content and bioavailability of Fe, Zn and Ca in plants for human nutrition. Journal of the Science in Food and Agriculture 80 861–879.Google Scholar
Fung, EB, Ritchie, LD, Woodhouse, LR, Roehl, R & King, JC (1997) Zinc absorption in women during pregnancy and lactation: a longitudinal study. American Journal of Clinical Nutrition 66 80–88.CrossRefGoogle ScholarPubMed
Ganji, V & Kies, CV (1994) Zinc bioavailability and tea consumption. Plant Foods for Human Nutrition 46 267–276.CrossRefGoogle ScholarPubMed
Garg, HK & Arshad, SK (1993) A study of the effect of oral zinc supplementation during pregnancy on pregnancy outcome. Indian Journal of Physiology and Pharmacology 37 276–284.Google Scholar
Gibson, RS (1993) Zinc nutrition in developing countries. Nutrition Research Reviews 10 1–18.Google Scholar
Gibson, RS & Ferguson, EL (1999) An Interactive 24-Hour Recall for Assessing the Adequacy of Iron and Zinc Intakes in Developing Countries. Washington, DC: ILSI Press.Google Scholar
Gibson, RS & Hotz, C (2001) Dietary diversification/modification strategies to enhance micronutrient content and bioavailability of diets in developing countries. British Journal of Nutrition 85 S159–S166.Google Scholar
Gibson, RS & Huddle, JMC (1998) Suboptimal zinc status in pregnant Malawian women: its association with low intakes of poorly available zinc, frequent reproductive cycling and malaria. American Journal of Clinical Nutrition 67 702–709.CrossRefGoogle ScholarPubMed
Gibson, RS, Yeudall, F, Drost, N, Mtitimuni, B, Cullinan, T (1998) Dietary interventions to prevent zinc deficiency. American Journal of Clinical Nutrition 68 Suppl. 484S–487S.CrossRefGoogle ScholarPubMed
Gibson, RS, Yeudall, F, Drost, N, Mtitimuni, BM, Cullinan, TR (2003) Experiences of a community-based dietary intervention to enhance micronutrient adequacy of diets low in animal source foods and high in phytate: a case study in rural Malawian children. Journal of Nutrition 133 3992S–3999S.CrossRefGoogle ScholarPubMed
Golden, MHN (1988) The diagnosis of zinc deficiency. In Zinc in Human Biology, pp. 323–333 [Mills, CF, editor]. London: Springer-Verlag.Google Scholar
Goldenberg, RL, Neggers, Y, Cooper, RL, Johnston, KE, DuBard, MB & Hauth, JC (1995) The effect of zinc supplementation on pregnancy outcome. Journal of the American Medical Association 274 463–468.CrossRefGoogle ScholarPubMed
Hambidge, KM (1989) Mild zinc deficiency in children. In Zinc in Human Biology, pp. 285–295 [Mills, CF, editor]. Berlin: Springer-Verlag.Google Scholar
Hambidge, KM (1997) Zinc deficiency in children. American Journal of Clinical Nutrition 165 160–161.Google Scholar
Hambidge, KM, Hambidge, C, Jacobs, M & Baum, JD (1972) Low levels of zinc in hair, anorexia, poor growth and hypogeusia in children. Pediatric Research 6 868–874.Google Scholar
Hambidge, KM, Huffer, JW, Raboy, V, Grunwald, GK, Westcott, JL, Sian, L, Miller, LV, Dorsch, JA & Krebs, NF (2004) Zinc absorption from low-phytate hybrids of maize and their wild-type isohybrids. American Journal of Clinical Nutrition 79 1053–1059.CrossRefGoogle ScholarPubMed
Hambidge, KM, Krebs, NF, Walravens, PA (1985) Growth velocity of young children receiving a dietary zinc supplement. Nutrition Research 1 306–316.Google Scholar
Hirsch, RS & Sussman, MR (1999) Improving nutrient capture from soil by the genetic manipulation of crop plants. Trends in Biotechnology 17 356–361.Google Scholar
Hooda, PS, Henry, CJK, Seyoum, TA, Armstrong, LDM & Fowler, MB (2004) The potential impact of soil ingestion on human mineral nutrition. Science of the Total Environment 333 75–87.CrossRefGoogle ScholarPubMed
Hotz, C & Brown, KM (2004) Assessment of the risk of zinc deficiency in populations and options for its control. Food and Nutrition Bulletin 25 S99–S199.Google Scholar
Hotz, C, DeHaene, J, Woodhouse, LR, Villalpando, S, Rivera, JA, King, JC (2005) Zinc absorption from zinc oxide, zinc sulfate, zinc oxide+EDTA, or sodium-zinc EDTA does not differ when added as fortificants to maize tortillas. Journal of Nutrition 135 1102–1105.Google Scholar
Hotz, C & Gibson, RS (2001) Assessment of home-based processing methods to reduce phytate content and phytate/zinc molar ratios of white maize (Zea mays). Journal of Agricultural and Food Chemistry 49 692–698.CrossRefGoogle ScholarPubMed
Huddle, JM, Gibson, RS, Cullinan, TR (1998) Is zinc a limiting nutrient in the diets of rural pregnant Malawian women? British Journal of Nutrition 79 257–265.CrossRefGoogle ScholarPubMed
Institute of Medicine (2001) Dietary Reference Intakes. Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press.Google Scholar
King, JC (2001) Effect of reproduction on the bioavailability of calcium, zinc, and selenium. Journal of Nutrition 131 1355S–1358S.CrossRefGoogle ScholarPubMed
Kohn, S, Kohn, D, Schiller, D (2000) Effect of zinc supplementation on epidermal Langerhans'cells of elderly patients with decubital ulcers. Journal of Dermatology 27 2558–2563.Google Scholar
Lönnerdal, B (2000) Dietary factors influencing zinc absorption. Journal of Nutrition 130 1378S–1383S.Google Scholar
Lönnerdal, B (2004) Interactions between micronutrients: synergies and antagonism. In Micronutrient Deficiencies during the Weaning Period and the First Years of Life. Nestle Nutrition Workshop Series Pediatric Program, vol. 54, pp. 67–81 [Pettifor, JM and Zlotkin, S, editors]. Vevey, Switzerland: S. Karger AG.CrossRefGoogle Scholar
Lönnerdal, B, Sandberg, A-S, Sandström, B, Kunz, C (1989) Inhibitory effects of phytic acid and other inositol phosphates on zinc and calcium absorption in suckling rats. Journal of Nutrition 119 211–214.Google Scholar
Lopez de Romaña, D, Brown, K, Guinard, J-X (2002) Sensory trials to assess the acceptability of zinc fortificants added to iron-fortified wheat products. Journal of Food Science 67 461–465.Google Scholar
Lopez de Romaña, D, Lönnerdal, B & Brown, K (2003) Absorption of zinc from wheat products fortified with iron and either zinc sulfate or zinc oxide. American Journal of Clinical Nutrition 78 279–283.Google Scholar
Mahalanabis, D, Chowdhury, A, Jana, S, Bhattacharya, MK, Chakrabarti, MK, Wahed, MA, Khaled, MA (2002) Zinc supplementation as adjunct therapy in children with measles accompanied by pneumonia: a double-blind, randomized controlled trial. American Journal of Clinical Nutrition 76 604–607.CrossRefGoogle ScholarPubMed
Mahalanabis, D, Madhurima, L, Paul, D, Gupta, A, Wahed, MA, Khaled, MA (2004) Randomized, double-blind, placebo-controlled clinical trial of the efficacy of treatment with zinc or vitamin A in infants and young children with severe acute lower respiratory infection. American Journal of Clinical Nutrition 79 430–436.Google Scholar
Makola, D, Ash, DM, Tatala, SR, Latham, MC, Ndossi, G, Mehansho, H (2003) A micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women. Journal of Nutrition 133 1339–1346.CrossRefGoogle ScholarPubMed
Manary, MJ, Hotz, C, Krebs, NF, Gibson, RS, Westcott, JE, Arnold, T, Broadhead, RL, Hambidge, KM (2000) Dietary phytate reduction improves zinc absorption in Malawian children recovering from tuberculosis but not in well children. Journal of Nutrition 130 2959–2964.CrossRefGoogle Scholar
Manary, MJ, Hotz, C, Krebs, NF, Gibson, RS, Westcott, JE, Broadhead, RL & Hambidge, KM (2002) Zinc homeostasis in Malawian children consuming a high-phytate, maize-based diet. American Journal of Clinical Nutrition 75 1057–1061.Google Scholar
Meeks Gardner, JM, Powell, CA, Baker-Henningham, H, Walker, SP, Cole, TJ, Grantham-McGregor, SM (2005) Zinc supplementation and psychosocial stimulation: effects on the development of undernourished Jamaican children. American Journal of Clinical Nutrition 82 399–405.Google Scholar
Menzies, IS, Zuckerman, MJ, Nukajam, WS, Somasundaram, SG, Murphy, B, Jenkins, AP, Crane, RS & Gregory, GG (1999) Geography of intestinal permeability and absorption. Gut 44 483–489.Google Scholar
Merialdi, M, Caulfield, LE, Zavaleta, N, Figueroa, A & DiPietro, JA (1998) Adding Zn to prenatal iron and folates tablets improves fetal neurobehavioral development. American Journal of Obsterics and Gynecology 180 483–490.CrossRefGoogle Scholar
Merialdi, M, Caulfield, LE, Zavaleta, N, Figueroa, A, Dominici, F & DiPietro, JA (2004) Randomized controlled trial of prenatal zinc supplementation and the development of fetal heart rate. American Journal of Obsterics and Gynecology 190 1106–1112.CrossRefGoogle ScholarPubMed
Muller, O, Becher, H, van Zweeden, AB, Ye, Y, Diallo, DA, Konate, AT, Gbangou, A, Kouyate, B & Garenne, M (2001) Effect of zinc supplementation on malaria and other causes of morbidity in west African children: randomised double blind placebo-controlled trial. British Medical Journal 322 1567CrossRefGoogle ScholarPubMed
Nestel, P, Briend, A, de Benoist, B, Decker, E, Ferguson, E, Fontaine, O, Micardi, A, Nalubola, R (2003) Complementary food supplements to achieve micronutrient adequacy for infants and young children. Journal of Pediatric Gastroenterology and Nutrition 36 316–328.Google ScholarPubMed
Oberleas, D & Harland, BF (1981) Phytate content of foods: effect on dietary zinc bioavailability. Journal of the American Dietetic Association 79 433–436.CrossRefGoogle ScholarPubMed
Osendarp, SJ, van Raaij, JM, Arifeen, SE, Wahed, M, Baqui, AH, Fuchs, GJ (2000) A randomized, placebo-controlled trial of the effect of zinc supplementation during pregnancy on pregnancy outcome in Bangladeshi urban poor. American Journal of Clinical Nutrition 71 114–119.Google Scholar
Osendarp, SJM, van Raaij, JMA, Darmstadt, GL, Baqui, AH, Hautvast, JG, Fuchs, GJ (2001) Zinc supplementation during pregnancy and effects on growth and morbidity in low birthweight infants: a randomized placebo controlled trial. Lancet 357 1080–1095.CrossRefGoogle Scholar
Osendarp, SJM, West, CE, Black, RE (2003) The need for maternal zinc supplementation in developing countries: an unresolved issue. Journal of Nutrition 133 817S–827S.CrossRefGoogle ScholarPubMed
Pabon, M, Lönnerdal, B (1992) Effect of citrate on zinc bioavailability from milk, milk fractions and infant formulas. Nutrition Research 13 103–111.CrossRefGoogle Scholar
Perlas, L & Gibson, RS (2002) Use of soaking to enhance the bioavailability of iron and zinc from rice-based complementary foods used in the Philippines. Journal of the Science of Food and Agriculture 82 1115–1124.CrossRefGoogle Scholar
Prasad, AS, Miale, A, Farid, Z, Sandstead, HH, Schulert, AR (1963) Zinc metabolism in patients with syndrome of iron deficiency anemia, hepatosplenomegaly, dwarfism and hypogonadism. Journal of Laboratory and Clinical Medicine 61 537–549.Google Scholar
Raboy, V, Below, FE, Dickinson, DB (1989) Alterations of maize kernel phytic acid levels by recurrent selection for protein and oil. Journal of Heredity 80 311–315.Google Scholar
Robberstad, B, Strand, T, Black, RE & Sommerfelt, H (2004) Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhea in developing countries. Bulletin of the World Health Organization 82 523–531.Google ScholarPubMed
Ruz, M, Castillo-Duran, C, Lara, X, Codoceo, J, Rebolledo, A & Atalah, E (1997) A 14-mo zinc-supplementation trial in apparently healthy Chilean preschool children. American Journal of Clinical Nutrition 66 1406–1413.CrossRefGoogle ScholarPubMed
Sandstead, HH, Penland, JG, Alcock, NW, Dayal, HH, Chen, XC, Li, JS, Zhao, F & Yang, JJ (1998) Effects of repletion with zinc and other micronutrients on neuropsychologic performance and growth of Chinese children. American Journal of Clinical Nutrition 68 470S–475S.Google Scholar
Sandström, B (2001) Micronutrient interactions: effect on absorption and bioavailability. British Journal of Nutrition 85 S181–S185.Google Scholar
Sandström, B, Almgren, A, Kivsto, B & Cederblad, A (1989) Effect of protein and protein source on zinc absorption in humans. Journal of Nutrition 119 48–53.Google Scholar
Sandström, B, Davidsson, L, Cederblad, A, Lönnerdal, B (1985) Oral iron, dietary ligands and zinc absorption. Journal of Nutrition 115 411–414.Google Scholar
Sazawal, S, Bentley, M, Black, RE, Dhingra, P, George, S & Bhan, MK (1996) Effect of zinc supplementation on observed activity in low socioeconomic Indian preschool children. Pediatrics 98 1132–1137.Google Scholar
Sazawal, S, Black, RE, Menon, VP, Dinghra, P, Caulfield, LE, Dhingra, U, Bagati, A (2001) Zinc supplementation in infants born small for gestational age reduces mortality: a prospective, randomized, controlled trial. Pediatrics 108 1280–1286.CrossRefGoogle ScholarPubMed
Shankar, AH, Genton, B, Baisor, M, Paino, J, Tamja, S, Adiguma, T et al. (2000) The influence of zinc supplementation on morbidity due to Plasmodium falciparum: a randomized trial in preschool children in Papua New Guinea. American Journal of Tropical Medicine and Hygiene 62 663–669.CrossRefGoogle ScholarPubMed
Smuts, CM, Lombard, CJ, Benade, AJS, Dhansay, MA, Berger, J, Hop, LT, Lopez de Romana, G, Untoro, J, Karyadi, E, Erhardt, J & Gross, R (2005) Efficacy of a foodlet-based multiple micronutrient supplement for preventing growth faltering, anemia, and micronutrient deficiency of infants: the four country IRIS trial pooled data analysis. Journal of Nutrition 135 631S–638S.CrossRefGoogle ScholarPubMed
Sturniolo, GC, Montino, C, Rossetto, L, Martin, A, D'Inca, R, D'Odorico, A, Naccarato, R (1991) Inhibition of gastric acid secretion reduces zinc absorption in man. Journal of the American College of Nutrition 10 372–375.CrossRefGoogle ScholarPubMed
Sunanda, L, Sumathi, S, Venkatasubbaiah, V (1995) Relationship between soil zinc, dietary zinc and zinc nutritional status of humans. Plant Foods for Human Nutrition 48 201–207.CrossRefGoogle ScholarPubMed
Temple, L, Gibson, RS & Hotz, C (2002) Use of soaking and enrichment for improving the content and bioavailability of calcium, iron and zinc in complementary foods and diets of rural Malawian weanlings. Journal of Food Science 67 1926–1932.Google Scholar
Torrejon, CS, Castillo-Suran, C, Hertrampf, ED & Ruz, M (2004) Zinc and iron nutrition in Chilean children fed fortified milk provided by the Complementary National Food Program. Nutrition 20 177–180.CrossRefGoogle ScholarPubMed
Turnlund, JR, King, JC, Keyes, WR, Gong, B & Michel, MC (1984) A stable isotope study of zinc absorption in young men: effects of phytate and α-cellulose. American Journal of Clinical Nutrition 40 1071–1077.Google Scholar
United Nations (1991) Some options for improving nutrition in the 1990's. SCN News no. 7, Suppl., 16–18.Google Scholar
Villalpando, S, Garcia-Guerra, A, Ramirez-Sliva, CI, Mejoa-Rodriguez, F, Matute, G, Shamah-Levy, T & Rivera, JA (2003) Iron, zinc and iodine status in Mexican children under 12 years and women 12–49 y of age. A probablistic national survey. Salud Publica de Mexico 45 S520–S529.Google Scholar
Walravens, PA & Hambidge, KM (1976) Growth of infants fed a zinc supplemented formula. American Journal of Clinical Nutrition 29 1114–1121.Google Scholar
Welch, RM & Graham, RD (2004) Breeding for micronutrients in staple food crops from a human nutrition perspective. Journal of Experimental Botany 55 353–364.CrossRefGoogle ScholarPubMed
World Health Organization (1996) Trace Elements in Human Nutrition and Health. Geneva: WHO.Google Scholar
World Health Organization (1997) WHO Global Database on Child Growth and Malnutrition. Geneva: WHO.Google Scholar
World Health Organization (1999) Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. Geneva: WHO.Google Scholar
World Health Organization/UNICEF (2004) Clinical Management of Acute Diarrhoea. Geneva: WHO.Google Scholar
Yilmaz, A, Ekiz, H, Torun, B, Göltekin, I, Karanlyk, S, Bagcy, SA & Cakmak, I (1997) Effect of different zinc application methods on grain yield, and zinc concentrations in wheat grown on zinc-deficient calcareous soils in Central Anatolia. Journal of Plant Nutrition 20 461–471.CrossRefGoogle Scholar
Zinc Against Plasmodium Study Group (2002) Effect of zinc on the treatment of Plasmodium falciparum malaria in children: a randomized controlled trial. American Journal of Clinical Nutrition 76 805–812.Google Scholar
Zlotkin, S, Arthur, P, Schauer, C, Antwi, KY, Yeung, G, Piekarz, A (2003) Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. Journal of Nutrition 133 1075–1080.Google Scholar
Zlotkin, SH & Cherian, MG (1988) Hepatic metallothionein as a source of zinc and cysteine during the first year of life. Pediatric Research 24 326–329.Google Scholar