Low Serum Zinc and short stature in children

Background Short stature/stunting is common in developing countries, and has been used as an indicator of a nation’s general health condition. Short stature increases the risk of metabolic disease, disturbances in cognitive development, infection prevalence, physical as well as functional deficits, and even death. Nutritional factors that frequently cause stunting are low intake of energy, protein, or micronutrients such as iron, vitamin A, and zinc. The role of zinc supplementation in children with short stature has not been well defined. In addition, zinc supplementation should be evaluated in the setting of specific conditions and regions. Objective To assess the association between low serum zinc level and short stature in children. Methods This cross-sectional study was done in a primary health care center at Klungkung I, Klungkung District, from August to September 2013. Children with short and normal stature (as reference group) were enrolled and their serum zinc level was measured, Other risk factors were inquired by questionnaire. Association between low serum zinc level (<65 µg/dL) and short stature was analyzed by stepwise multivariable regression analysis; degree of association was presented as odds ratio (OR) and its corresponding confidence interval. Results The prevalence of low serum zinc level in our subjects was 71%. Low serum zinc level was significantly associated with short stature [adjusted OR 16.1; 95%CI 3.1 to 84.0; (P=0.001)]. In addition, the occurrence of low serum zinc was higher in the short stature group (88.5%) compared to the normal stature group (53.8%). We also found that low calorie intake was associated with short stature [adjusted OR 29.4; 95%CI 2.76 to 314.7; (P=0.001)]. Conclusion Low serum zinc level appears to be associated with short stature. [Paediatr Indones. 2016;56:171-5.]. Keywords: zinc; short stature; children From the Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali, Indonesia. Reprint requests to: Kadek Wini Mardewi, MD, Department of Child Health, Udayana University Medical School/Sanglah Hospital, Jalan Pulau Nias, Denpasar, Bali 80114, Indonesia. Telp. +62-361-244038; Fax +62-361-244038; Email: winimardewi@yahoo.co.id. Short stature (stunting) is commonly found in developing countries and has been used as an indicator of the general health condition of a nation. A survey conducted in Indonesia showed that 31.4% of children had short stature.1 In Bali, the prevalence of children below 5 years of age with short stature was 36.4%.2 Short stature increases the risk of metabolic diseases such as type II diabetes in adolescence.3 In addition, short stature increases the prevalence of infectious diseases, physical as well as functional deficits, and causes death in approximately 2.1 million children below 5 years of age worldwide.4 Factors affecting malnutrition in toddlers include genetics, hormones, gender, infectious diseases, and chronic diseases.5-9 Nutritional factors that cause stunting include low intake of energy, protein, and micronutrients such as iron, vitamin A, and zinc.10,11 Zinc deficiency may lead to anorexia, which has implications for DNA and RNA synthesis for replication and differentiation of chondrocytes and osteoblasts, declining immune system.12 Gibson et al. found a significant difference in serum zinc in boys with short stature compared to those with normal stature.11 The role of zinc supplementation in children with short