Zinc combined with vitamin A reduces upper respiratory tract infection morbidity in a randomised trial in preschool children in Indonesia

Zn supplementation has shown inconsistent effects on respiratory morbidity in young children in developing countries. Few studies have focused on upper respiratory tract infection (URTI), a frequent cause of morbidity in this group, and potential benefit from Zn supplementation or factors that influence its efficacy. We investigated the effects of Zn supplementation on URTI before and after vitamin A supplementation. This randomised double-blinded controlled Zn supplementation study was conducted on 826 children aged 2-5 years. Placebo or Zn (10 mg/d) was given in syrup daily for 4 months, with 200 000 IU vitamin A (60 mg retinol) given to all children at 2 months. Health workers visited children every 3 d for compliance and morbidity information. We found that 84% of children experienced URTI during the study. Zn supplementation reduced the percentage of days with URTI (12% reduction; P=0.09), with greater impact following vitamin A supplementation (20% reduction; P=0.01). Vitamin A supplementation was associated with a decreased number but an increased duration of URTI episodes. We conclude that Zn combined with vitamin A supplementation significantly reduced the percentage of days with URTI in a population of preschool Indonesian children with marginal nutritional status. The results suggest that vitamin A status modifies the efficacy of Zn supplementation on URTI.