A Randomized Controlled Trial on Zinc Supplementation for Prevention of Acute Respiratory Infections in Infants

Zinc Supplementation for Prevention of ARI


  • Arshad Khan Department of Pediatric Medicine, Nowshera Medical College/Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan
  • Hamayun Anwar Department of Pediatric Medicine, Nowshera Medical College/Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan
  • Anila Farhat Frontier Medical College, Abbottabad, Pakistan
  • Ajaz Ahmed King Abdullah Teaching Hospital, Mansehra, Pakistan
  • Irfan Khan Department of Pediatric Medicine, Nowshera Medical College/Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan 2
  • Irfan Ullah Department of Pediatric Medicine, Nowshera Medical College, Nowshera, Pakistan




Zinc Supplementation, Acute Respiratory Infections, Infants


There is little evidence that zinc supplementation will be effective in treating acute respiratory infection (ARI), but it may prevent respiratory infections when taken in conjunction with antibiotics. Objective: To assess the zinc supplementation for acute respiratory infection prevention in infants. Methods: A randomized controlled trail was conducted on 120 acute respiratory infected infants in Pediatric Unit, Qazi Hussain Ahmad Medical Complex, Nowshera from 1st January 2022 to 30th June 2022. Infants having 6-14 months of age with acute respiratory infections were enrolled. Infants were allocated to two groups: Group-I infants receiving Zinc (20 mg/5 mL) in terms of Zinc sulphate (N=60) and Group-II infants taking syrup (Placebo) (N=60). Results: Of the total 220 episodes, the frequency of episodes in zinc and placebo group was 106 and 114 respectively, accounting for 7.78 and 8.68 per child year after 5 months. Based on GEE regression model observed an insignificant decrease of 8% (Adjusted IRR 0.89, 95% CI 0.79-1.01) in episodes of acute respiratory infections in zinc group as compared to placebo group. However, acute respiratory infections episodes (Adjusted IRR 0.36, 95% CI: 0.25-0.35) decreased by 60% in zinc group. Zinc supplementation reduced the acute respiratory days significantly by 14% (Adjusted RR 0.83, 95% CI: 0.76-0.92). Conclusions:  Prophylactic zinc supplementation for two weeks decreased acute lower respiratory tract infection morbidity in apparently healthy infants and improved the infant’s recovery from acute respiratory infections and reduced their hospitalization as compared to placebo group


Barffour MA, Hinnouho GM, Wessells KR, Kounnavong S, Ratsavong K, Sitthideth D, et al. Effects of therapeutic zinc supplementation for diarrhea and two preventive zinc supplementation regimens on the incidence and duration of diarrhea and acute respiratory tract infections in rural Laotian children: A randomized controlled trial. Journal of Global Health. 2020 Jun; 10(1): 010424. doi: 10.7189/jogh.10.010424.

Rerksuppaphol S and Rerksuppaphol L. A randomized controlled trial of zinc supplementation in the treatment of acute respiratory tract infection in Thai children. Pediatric Reports. 2019 May; 11(2) :7954. doi: 10.4081/pr.2019.7954.

Khera D, Singh S, Purohit P, Sharma P, Singh K. Prevalence of Zinc Deficiency and the Effect of Zinc Supplementation on the Prevention of Acute Respiratory Infections. Turkish Thoracic Journal. 2020 Nov; 21(6): 371.

Moshtagh M and Amiri R. Role of zinc supplementation in the improvement of acute respiratory infections among Iranian children: a systematic review. Tanaffos. 2020 Jan; 19(1): 1.

A, Taneja DK, Devasenapathy N, Rajeshwari K. Zinc supplementation for prevention of acute respiratory infections in infants: a randomized controlled trial. Indian Pediatrics. 2014 Oct; 51: 780-4. doi: 10.1007/s13312-014-0503-z.

Wessells KR, Brown KH, Arnold CD, Barffour MA, Hinnouho GM, Killilea DW, et al. Plasma and nail zinc concentrations, but not hair zinc, respond positively to two different forms of preventive zinc supplementation in young laotian children: a randomized controlled trial. Biological Trace Element Research. 2021 Feb; 199(2): 442-52. doi: Malik 10.1007/s12011-020-02163-2.

Mokdad AH, Forouzanfar MH, Daoud F, El Bcheraoui C, Moradi-Lakeh M, Khalil I, et al. Health in times of uncertainty in the eastern Mediterranean region, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Global Health 2016 Oct; 4(10): e704–13.

Khoushabi F, Shadan MR, Miri A, Sharifi-Rad J. Determination of Maternal Serum Zinc, Iron, Calcium and Magnesium during Pregnancy in Pregnant Women and Umbilical Cord Blood and Their Association with Outcome of Pregnancy. Materia Socio-medica 2016 Apr; 28(2): 104–7. doi: 10.5455/msm.2016.28.104-107.

Neyestani TR, Nikooyeh B, Hajifaraji M, Kalayi A. The prevalence of zinc deficiency and its correlation with iron status and economical living area in 9-12-year-old children. International Journal of Vitamin Nutrition Research. 2016 Feb; 86(1-2): 18-26. doi: 10.1024/0300-9831/a000240.

Rahmati M, Safdarian F, Zakeri M, Zare S. The prevalence of zinc deficiency in 6-month to 12-year-old children in Bandar Abbas in 2013. Electronic Physician. 2017 Aug; 9(8): 5088. doi: 10.19082/5088.

Sampaio DL, De Mattos ÂP, Ribeiro TC, Leite ME, Cole CR, Costa-Ribeiro Jr H. Zinc and other micronutrients supplementation through the use of sprinkles: impact on the occurrence of diarrhea and respiratory infections in institutionalized children. Jornal de Pediatria. 2013 May; 89(3): 286-93. doi: 10.1016/j.jped.2012.11.004.

World Health Organization. UNICEF.: Zinc supplementation in the management of diarrhoea. [Last Cited: 28th September 2016]. Available at: http://wwwwhoint/elena/titles/zinc_diarrhoea/en/ 2016

Bonaventura P, Benedetti G, Albarède F, Miossec P. Zinc and its role in immunity and inflammation. Autoimmunity Reviews. 2015 Apr; 14(4): 277-85. doi: 10.1016/j.autrev.2014.11.008.

Roohani N, Hurrell R, Kelishadi R, Schulin R. Zinc and its importance for human health: An integrative review. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2013 Feb; 18(2): 144.

Read SA, Obeid S, Ahlenstiel C, Ahlenstiel G. The role of zinc in antiviral immunity. Advances in nutrition. 2019 Jul; 10(4): 696-710. doi: 10.1093/advances/nmz013

Lassi ZS, Moin A, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database of Syst Rev. 2016;12:CD005978. doi: 10.1002/14651858.CD005978.pub3.

Malik A, Taneja DK, Devasenapathy N, Rajeshwari K. Zinc supplementation for prevention of acute respiratory infections in infants: a randomized controlled trial. Indian Pediatrics. 2014 Oct; 51:780-4. doi: 10.1007/s13312-014-0503-z.

Adhikari DD and Das S. Role of zinc supplementation in the outcome of repeated acute respiratory infections in Indian children: a randomized double blind placebo-controlled clinical trial. Research Journal of Pharmacy and Technology. 2016;9(4):457-8. doi: 10.5958/0974-360X.2016.00084.6.

Sánchez J, Villada OA, Rojas ML, Montoya L, Díaz A, Vargas C, et al. Effect of zinc amino acid chelate and zinc sulfate in the incidence of respiratory infection and diarrhea among preschool children in child daycare centers. Biomedica. 2014 Mar; 34(1): 79-91. doi: 10.7705/biomedica.v34i1.1581.

Sharma U and Yadav N. Prevalence and risk factors of anemia and zinc deficiency among 4–6-year-old children of Allahabad district, Uttar Pradesh. Indian Journal of Public Health. 2019 Mar; 63(1) :79–82. doi: 10.4103/ijph.IJPH_342_17.

Chao HC, Chang YJ, Huang WL. Cut‐off Serum Zinc Concentration Affecting the Appetite, Growth, and Nutrition Status of Undernourished Children Supplemented with Zinc. Nutrition in Clinical Practice. 2018 Oct; 33(5): 701-10. doi: 10.1002/ncp.10079.

Nair H, Simões EA, Rudan I, Gessner BD, Azziz-Baumgartner E, Zhang JS, et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. The Lancet. 2013 Apr; 381(9875): 1380-90. doi: 10.1016/S0140-6736(12)61901-1.

Baqui AH, Black RE, El Arifeen S, Yunus M, Chakraborty J, Ahmed S, et al. Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial. Bmj. 2002 Nov; 325(7372): 1059. doi: 10.1136/bmj.325.7372.1059.

Brown KH, Sonja YS, Peerson JM, Baker SK. Does preventive zinc supplementation of infants and young children affect their risk of selected illnesses, survival, and physical growth. Food Nutrition Bulletin. 2009; 30: S12-S40. doi: 10.1177/15648265090301S103.

Wang L and Song Y. Efficacy of zinc given as an adjunct to the treatment of severe pneumonia: A meta‐analysis of randomized, double‐blind and placebo‐controlled trials. The Clinical Respiratory Journal. 2018 Mar; 12(3): 857-64. doi: 10.1111/crj.12646.

Yuan X, Qian SY, Li Z, Zhang ZZ. Effect of zinc supplementation on infants with severe pneumonia. World Journal of Pediatrics. 2016 May; 12: 166-9. doi: 10.1007/s12519-015-0072-9.

Wessells KR, Brown KH, Kounnavong S, Barffour MA, Hinnouho GM, Sayasone S, et al. Comparison of two forms of daily preventive zinc supplementation versus therapeutic zinc supplementation for diarrhea on young children’s physical growth and risk of infection: study design and rationale for a randomized controlled trial. BMC Nutrition. 2018 Dec; 4: 1-9. doi: 10.1186/s40795-018-0247-6 .

SoukAloun D, Douangbouphaa V, Phetsouvanh R, Sibounheuang B, Vongsouvat M, Chanmala K, et al. Rotavirus diarrhea in hospitalized children under 5 years of age in Vientiane, Lao PDR, 2009–2015. Vaccine. 2018 Dec; 36(51): 7878-82. doi: 10.1016/j.vaccine.2018.04.004.

McDonald CM, Manji KP, Kisenge R, Aboud S, Spiegelman D, Fawzi WW, et al. Daily zinc but not multivitamin supplementation reduces diarrhea and upper respiratory infections in Tanzanian infants: a randomized, double-blind, placebo-controlled clinical trial. The Journal of Nutrition. 2015 Sep; 145(9): 2153-60. doi: 10.3945/jn.115.212308.

de Medeiros Rocha ÉD, de Brito NJ, Dantas MM, de Araújo Silva A, das Graças Almeida M, Brandão-Neto J. Effect of zinc supplementation on GH, IGF1, IGFBP3, OCN, and ALP in non-zinc-deficient children. Journal of the American College of Nutrition. 2015 Jul; 34(4): 290-9. doi: 10.1080/07315724.2014.929511.

Cho HE, Myung SK, Cho H. Efficacy of Vitamin D supplements in prevention of acute respiratory infection: A meta-analysis for randomized controlled trials. Nutrients. 2022 Feb; 14(4): 818. doi: 10.3390/nu14040818.




How to Cite

Khan, A. ., Anwar, H. ., Farhat, A. ., Ahmed, A. ., Khan, I. ., & Ullah, I. . (2023). A Randomized Controlled Trial on Zinc Supplementation for Prevention of Acute Respiratory Infections in Infants : Zinc Supplementation for Prevention of ARI. Pakistan Journal of Health Sciences, 4(04), 128–132. https://doi.org/10.54393/pjhs.v4i04.696



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