Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an important part of patient care. Malnutrition in hospitalized patients is associated with significant complications, including increased infection risks, poor wound healing, prolonged hospital stay and increased mortality, especially in surgical and critically ill patients.
Nutritional support therapy is aimed at meeting patient’s nutritional requirements, improving energy and net protein balance, promoting growth or weight maintenance, and improving healing, particularly in malnourished patients. The desired outcomes and goals of providing nutrition support therapy include,
- Weight maintenance (potential weight gain in malnourished patients and growing children)
- Preservation (or repletion) of lean body mass and visceral proteins.
- Support of anabolism and nitrogen balance.
- Correction or avoidance of fluid and electrolyte abnormalities
- Correction or avoidance of vitamin and trace element abnormalities.
- Avoidance of further nutritional deficiencies
Importance of Zinc in Biochemical Processes
Trace elements are essential cofactors for numerous biochemical processes, therefore adequate nutrition is important to maintain optimal health.
Zinc is a trace element that serves as an enzymatic cofactor and protects cell from lysis through compliment activation and toxin release. Zinc is contained mainly in bones, teeth, hair, skin, liver muscle, leukocytes and testes, it is a component of several hundred enzymes, including many Nicotinamide Adenine Dinucleotide (NADH) dehydrogenases, RNA and DNA polymerases, and DNA transcription factors as well as alkaline phosphatase, superoxide dismutase and carbonic anhydrase, however a diet high in fiber and phytate (eg, containing whole-grain bread) reduces zinc absorption.
Effects of Zinc Deficiency
Zinc is an essential component in hundreds of cellular and enzymatic processes. In developing countries, zinc deficiencies have been documented in both children and adults. Dietary deficiency is uncommon in developed countries but secondary deficiency is more common. Secondary zinc deficiency develops in some patients with hepatic insufficiency (because the ability to retain zinc is lost), patients receiving diuretics, and those with diabetes mellitus, sickle cell disease, chronic renal failure, malabsorption, or stressful conditions (eg septicemia, burns, head injury). Zinc deficiency is extremely common among elderly institutionalized and homebound patients and patients with lung cancer.
Maternal zinc deficiency may cause fetal malformations and low birth weight.
Zinc deficiency in children causes impaired growth and impaired taste (hypogeusia). Other signs and symptoms in children include delayed sexual maturation and hypogonadism. In children or adults, symptoms include hypospermia, alopecia, impaired immunity, anorexia, dermatitis, night blindness, anemia, lethargy and impaired wound healing. With secondary deficiency, testosterone deficieny, night blindness, apathy, and irritability may develop.
Zinc deficiency should be suspected in undernourished patients with typical symptoms or signs. However, because many of the symptoms and signs are nonspecific, clinical diagnosis of mild zinc deficiency is difficult. Laboratory diagnosis is also difficult. Serum levels are often inaccurate; diagnosis usually requires the combination of low levels of zinc in serum or tissues (eg, in RBC, WBC, platelets, saliva, hair, or nails) and increased urinary zinc excretion. If available, isotope studies can measure zinc status more accurately.
Many of the clinical manifestations of zinc deficiencies;
- Growth retardation,
- Poor appetite
- Mental lethargy
- Delayed wound healing
- Susceptibility to infections
Are all reversible after supplementation.
According to the standard treatment guidelines ZINC/ORS is used for Diarrhoea treatment.
- Co packed will increase the uptake of Zinc hence decrease in the frequency of diarrhoea. There is big discrepancy between ORS use and zinc use. (44% vs 4.7%)
- ORS alone does not show the improvement of diarrhoea symptoms. You need to need to supplement it with Zinc, the use of zinc will reduce the duration and frequency of diarrhoea episodes up to three month. The role of ORS is to rehydrate the lost fluids from the body
- The cost for having copacked is higher than the use of ORS or Zinc alone but benefit bigger. We need to do awareness campaign on the benefit of using both ORS and Zinc and not ORS alone.
The fact that Zinc is an over the counter (OTC) drug. With OTC medicine, you do not need prescription, however, it still has to be sold at pharmacies rather than any shops while with ORS you can sell anywhere. This is one of the challenge for the discrepancy between ORS and Zinc use. Unless we solve this problem co-pack will be at the same level of zinc.