Zinc supplementation in the management of acute diarrhea in high-income countries a systematic review and meta-analysis

The World Health Organization (WHO) and the United Nations Children s Fund (UNICEF) recommend zinc supplementation for children with diarrhea. However, most of the studies supporting this recommendation were conducted in countries with low- middle-income countries (LMICs). Although the mortality rate of acute diarrhea in developed countries is low, diarrhea leads to a high number of clinical care and hospital admissions, which represents a significant economic burden. This systematic review assessed the therapeutic benefits of zinc supplementation in the treatment of acute diarrhea in children living in high-income countries. A literature search was conducted on Medline, Embase, Cochrane, and Scielo databases for published randomized controlled trials of zinc supplementation, and acute diarrhea in children living in developed countries. The systematic literature search of the databases uncovered 609 titles, and 3 trials with a total of 620 treated children with acute diarrhea were included after a subsequent review of abstracts and full manuscripts for inclusion and exclusion criteria. Two studies showed that zinc did not interfere with the duration of diarrhea. Based on the Cochrane Risk of Bias RoB2, the risk was considered low in two studies and some concerns in another. There was no statistically significant reduction in the mean RR for diarrheal episodes after 7 days of administering zinc supplements (0.4% vs 0.6%; RR 0.73; 95% CI 0.28-1.92; p=0.53; I2=16%). Zinc supplementation did not reduce the duration of acute diarrhea among children living in developed countries.