Impact of Two Forms of Daily Preventive Zinc or Therapeutic Zinc Supplementation for Diarrhea on Hair Cortisol Concentrations Among Rural Laotian Children: A Randomized Controlled Trial

Guy-Marino Hinnouho, Robin M Bernstein, Maxwell A Barffour, Charles D Arnold, K Ryan Wessells, Kethmany Ratsavong, Bangone Bounheuang, Sengchanh Kounnavong, Sonja Y Hess, Guy-Marino Hinnouho, Robin M Bernstein, Maxwell A Barffour, Charles D Arnold, K Ryan Wessells, Kethmany Ratsavong, Bangone Bounheuang, Sengchanh Kounnavong, Sonja Y Hess

Abstract

Zinc supplementation has been shown to reduce the morbidity burden among young children, and may reduce chronic stress. Hair cortisol has been promoted as an indicator of chronic stress. We assessed the impact of different strategies for delivering supplementary zinc on hair cortisol concentrations (HCC) in young Laotian children and examined risk factors associated with HCC. In a randomized double-blind controlled trial (NCT02428647), children aged 6⁻23 mo were randomized to one of four intervention groups and followed for ~36 weeks: daily preventive zinc (PZ) tablets (7 mg/day), daily multiple micronutrient powder (MNP) sachets (containing 10 mg zinc and 14 other micronutrients), therapeutic zinc (TZ) supplements for diarrhea treatment (20 mg/day for 10 days) or daily placebo powder. HCC of 512 children was assessed at baseline and endline. ANCOVA and linear regression models were used to assess group differences in HCC and to examine the risk factors associated with HCC, respectively. At enrollment, mean HCC was 28.8 ± 43.9 pg/mg. In models adjusted for age at enrollment, health district, and baseline HCC there was no overall effect of the interventions on endline HCC and change in HCC. When controlling for additional predetermined covariates, there was a marginally significant effect on change in HCC (p = 0.075) with a slightly lower reduction of HCC in TZ compared to PZ (mean change (95% CI): -4.6 (-7.0; -2.3) vs. -9.4 (-11.7; -7.0) pg/mg; p = 0.053). At baseline, consumption of iron rich foods was negatively associated with HCC, whereas AGP (α1-acid glycoprotein) levels, elevated AGP and C-reactive protein and high soluble transferrin receptor were positively associated with HCC. In young Laotian children, MNP, PZ and TZ had no impact on HCC. The marginal difference in change in HCC between the PZ and TZ groups was too small to be considered of health significance.

Keywords: Lao PDR; MNP; chronic stress; hair cortisol; micronutrient powder; young children; zinc supplementation.

Conflict of interest statement

The spouse of S.Y.H. works for the Bill & Melinda Gates Foundation.

Figures

Figure 1
Figure 1
Lao Zinc study flow diagram for hair collection. MNP = Micronutrient powder; PZ = preventive zinc; TZ = Therapeutic zinc.

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