Zinc and Health: Current Health and Future Directions

The close relationship between diarrheal disease and malnutrition has not escaped the attention of the medical community (Gracey 1996). The morbidity and mortality rates due to diarrheal disease are particularly severe in young children.In 1993 there were ;12 million deaths of infants and children, 5 y old, of which one fourth were related to diarrhea. Thvast majority occurred in developing countries. Fifty-eight percent, or 1.74 million, of the  ;3 million premature deaths due to diarrheal diseases have been associated with malnutrition(Fuchs 1998). These statistics suffice to convey the seriousness of the world public health problem. In contrast, since 1968 the United States has experienced a 75% decline in diarrheal disease deaths in children , 5 y old, which now number ;300/y (Kilgore et al. 1995). The interaction of factors linking diarrheal episodes, malnutrition and zinc depletion

is diagrammatically presented in Figure 1. Here we do address immunologic factors associated with zinc deficiency,which is an area that has been extensively reviewed (Shankar and Prasad 1998).

Effects of malnutrition on zinc status. The discovery of zinc deficiency in humans occurred in populations characterized by diets based on staples capable of reducing the bioavailability of metallic elements due to a high concentration of phytate. Another important and often concurrent feature of these diets has been their low protein content. This has been a consistent finding, supported by numerous studies carried out in Asia, Africa and Latin America (Prasad 1998). A typical instance of the link between a low protein intake and zinc deficiency has been documented in Vietnamese children, of whom 50% experience protein energy malnutrition during infancy (Ninh et al. 1996). Protein-energy malnutrition entails a decrease in the immunologic defense mechanisms that leads to greater susceptibility to infections, especially diarrheal disease. Nutritional rehabilitation with a high protein diet is a difficult task that if inappropriately handled can result in catastrophic outcome, because the alterations present in the gastrointestinal tract during severe food restriction can lead to malabsorption, diarrhea, electrolyte depletion and even death.

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