From the Guidelines
Zinc supplementation is crucial for individuals with confirmed zinc deficiency, those at high risk of deficiency, and in specific clinical scenarios, with daily supplementation of 15-30 mg elemental zinc recommended for adults with deficiency, as supported by the most recent and highest quality study 1. The indications and guidelines for zinc supplementation vary based on the individual's condition and age.
- For patients on parenteral nutrition with gastrointestinal losses, IV doses up to 12 mg per day can be used to maintain zinc status, as recommended by the espen micronutrient guideline 1.
- Patients with major burns >20% BSA require 30-35 mg/day IV for 2-3 weeks due to exudative losses, as stated in Recommendation 13.6 of the espen micronutrient guideline 1.
- In acquired zinc deficiency, 0.5-1 mg/kg per day of elemental zinc can be given orally for 3-4 months, with organic compounds like zinc histidinate, zinc gluconate, and zinc orotate showing better tolerability than inorganic zinc sulfate and zinc chloride, as recommended in Recommendation 13.7 of the espen micronutrient guideline 1.
- For acrodermatitis enteropathica, a life-long oral intake of 3 mg/kg per day of elemental zinc may be provided, with the dosage adjusted according to plasma or serum zinc levels, as stated in Recommendation 13.8 of the espen micronutrient guideline 1. Key points to consider when supplementing with zinc include:
- Maintaining a ratio of 8-15 mg of zinc for each 1 mg of copper to avoid zinc-induced copper deficiency, as recommended by the british obesity and metabolic surgery society guidelines 1.
- Monitoring zinc and copper levels periodically, especially in patients on long-term parenteral nutrition or with high gastrointestinal fluid output, as recommended by the espghan/espen/espr/cspen guidelines on pediatric parenteral nutrition 1.
- Providing zinc supplementation in accordance with the individual's age and condition, such as 400-500 μg/kg/d in preterm infants, 250 μg/kg/d in infants from term to 3 months, 100 μg/kg per day for infants from 3 to 12 months, and 50 μg/kg/d in children >12 months of age, as recommended by the espghan/espen/espr/cspen guidelines on pediatric parenteral nutrition 1.
From the Research
Indications for Zinc Supplementation
The indications for zinc supplementation include:
- Prevention of upper respiratory infection and diarrhea in developing countries 2
- Adjunct treatment for diarrhea in malnourished children 2
- Treatment of Wilson disease 2
- Slowing the progression of intermediate and advanced age-related macular degeneration in combination with antioxidants 2
- Reduction of respiratory tract infections in children with cystic fibrosis, particularly those with low plasma zinc levels 3
Guidelines for Zinc Supplementation
The guidelines for zinc supplementation are:
- Recommended dietary allowance (RDA) is 15 mg/day 4
- High intakes of zinc relative to copper can cause copper deficiency 5
- Excessive consumption of zinc supplements can cause chronic zinc toxicity 5
- Assessment of zinc nutriture is complex and involves chemical and functional measurements 5
- Zinc supplementation should be used with caution, as high doses can cause adverse effects such as suppressed immunity, decreased high-density lipoprotein cholesterol levels, anemia, and copper deficiency 2, 4
Benefits of Zinc Supplementation
The benefits of zinc supplementation include:
- Essential for many metabolic and enzymatic functions in the human body 6
- Important for cell division, DNA, RNA, and protein synthesis 6
- Plays a role in the protection of cell membrane integrity and may be protective against free radical injury 6
- Essential for immune function, including the activity of T-cells and neutrophils 6
- May be beneficial in reducing the number of days of oral antibiotics used to treat respiratory tract infections in children with cystic fibrosis 3