Zinc Absorption and Endogenous Fecal Zinc Losses in Bangladeshi Toddlers at Risk for Environmental Enteric Dysfunction

Prasenjit Mondal, Julie M Long, Jamie E Westcott, M Munirul Islam, Mondar Ahmed, Mustafa Mahfuz, Tahmeed Ahmed, Leland V Miller, Nancy F Krebs, Prasenjit Mondal, Julie M Long, Jamie E Westcott, M Munirul Islam, Mondar Ahmed, Mustafa Mahfuz, Tahmeed Ahmed, Leland V Miller, Nancy F Krebs

Abstract

Objectives: Environmental enteric dysfunction (EED) impairs zinc absorption from food, and zinc deficiency may contribute to the poor growth associated with EED. We examined zinc absorption from a standardized aqueous zinc dose, and habitual daily endogenous fecal zinc excretion (EFZ) and compared these outcomes between children grouped by the lactulose to mannitol ratio (L:M).

Methods: Bangladeshi toddlers (18-24 months) with low (<0.09) and high (≥0.09) L:M were administered isotope-labeled 3 mg aqueous zinc in the fasted state. Fractional absorption of zinc (FAZ) and EFZ were measured by dual stable isotope tracer method and an isotope dilution method, respectively. Secondary aims included examining relationships of biomarkers of systemic and intestinal inflammation and gut function with FAZ and EFZ.

Results: Forty children completed the study; nearly all had evidence of EED. No differences in zinc homeostasis measurements (mean ± SD) were observed between high and low L:M groups: FAZ was 0.38 ± 0.19 and 0.31 ± 0.19, respectively; both figures were within estimated reference range. Means of EFZ were 0.73 ± 0.27 and 0.76 ± 0.20 mg/day for high and low L:M, respectively, and were 10% to 15% above estimated reference range. Regression analyses indicated that biomarkers of systemic inflammation were directly associated with increasing FAZ, consistent with increased gut permeability. Biomarkers of intestinal inflammation were negatively associated with EFZ, consistent with low-zinc intake and chronic deficiency.

Conclusions: In these children at risk of EED, endogenous zinc losses were not markedly increased. Results suggest that efforts to improve zinc status in EED should focus on substantially improving zinc intakes.

Trial registration: ClinicalTrials.gov NCT02760095.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Fractional absorption of zinc versus quantity of ingested zinc shown for the aqueous fasting dose in the present study (circle symbols) and for a zinc-supplemented meal (x symbols) administered to a separate group of toddlers from the same Bangladeshi population (9). The greater variability in the fasting FAZ data is apparent, having a standard deviation of 0.19 compared with 0.06 for the FAZ from meals (taking into account the variation in FAZ with quantity of zinc in meal—dotted curve). ●—FAZ from aqueous zinc dose (high L:M, present study); ○—FAZ from aqueous zinc dose (low L:M, present study); x—FAZ from single meal supplemented with zinc. Data from (9). FAZ = fractional absorption of ingested zinc.

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