AzTrials
AzTrials

DiarrheaNCT03406793

Zinc-MNP Trial for Prevention of Diarrhea and Promotion of Linear Growth

A study testing Standard MNP, High zinc, low iron MNP and High zinc, low/no iron on alternating days in people with Diarrhea and Stunting, run by UCSF Benioff Children's Hospital Oakland at 1 site in Bangladesh.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

This is a randomized, double-blind, community-based efficacy trial of different doses, forms, and frequencies of zinc supplementation for the prevention of diarrhea and promotion of linear growth among children 9-11 months of age in Dhaka, Bangladesh. Read more about this study

Who is it for?
Ages 9 to 11 monthsHealthy volunteers can take part
Conditions the study is for
Diarrhea, Stunting
What is being tested?
Standard MNP, High zinc, low iron MNP and High zinc, low/no iron on alternating days
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
2,886 participants
Where
1 siteBangladesh
Study dates
20 Feb 2018to 12 Jan 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 9 to 11 months
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • 9-11 months of age
  • Weight-for-length Z score >= -3 according to the 2006 World Health Organization Growth Standards
  • Hemoglobin concentration > = 7.0 g/dL

Who cannot join

  • Presence of severe acute malnutrition, defined as a WLZ <-3 and/or the presence of bipedal edema and/or mid-upper arm circumference <115 mm;
  • Presence of severe anemia, defined as a hemoglobin concentration < 7.0 g/dL
  • Congenital anomalies (e.g. cardiac defects, cleft lip or palate) or any other conditions that interfere with feeding;
  • Chromosomal anomalies and other organic problems (e.g. jaundice, tuberculosis)
  • Currently consuming MNPs with no intention of stopping

Trial locations and contacts

1 site in 1 country.

Bangladesh1 site
  • Icddr,B

    Dhaka

Other trials in Bangladesh

About this study

Official title: Randomized, Double-blind, Community-based Efficacy Trial of Various Doses of Zinc in Micronutrient Powders or Tablets in Young, Bangladeshi Children

This is a randomized, double-blind, community-based efficacy trial of different doses, forms, and frequencies of zinc supplementation for the prevention of diarrhea and promotion of linear growth among children 9-11 months of age in Dhaka, Bangladesh.

Read the detailed description

Zinc is essential to support growth in young children especially for tissues undergoing rapid cellular differentiation and turnover, such as those in the immune system and gastrointestinal tract. Therapeutic zinc supplementation has been initiated in low-income countries as part of diarrhea treatment programs to support these needs for young children but, the effects of preventive supplemental zinc as a tablet or as a multiple micronutrient powder (MNP) on child growth and diarrheal disease are mixed and pose programmatic uncertainties. Thus, a randomized, double-blind community-based efficacy trial of five different doses, forms, and frequencies of preventive zinc supplementation vs. a placebo was designed for a study in children aged 9-11 months in an urban community in Dhaka, Bangladesh. The primary outcomes of this 24-week study are incidence of diarrheal disease and linear growth. Study workers will conduct in-home morbidity checks twice weekly; anthropometry will be measured at baseline, 12 weeks and 24 weeks. Serum zinc and other related biomarkers will be measured in a subsample along with an estimate of the exchangeable zinc pool size using stable isotope techniques in a subgroup. Therapeutic zinc will be provided as part of diarrhea treatment, in accordance with Bangladesh's national policy. Therefore, the proposed study will determine the additional benefit of a preventive zinc supplementation intervention.

Conditions
Diarrhea, Stunting
Being tested
Standard MNP, High zinc, low iron MNP, High zinc, low/no iron on alternating days, Dispersible zinc supplement, Intermittent zinc supplement
Keywords
Zinc, Multiple micronutrient powders, Diarrhea, Stunting
Medical subject headings
Diarrhea, Growth Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Standard MNPDietary supplement

    Standard MNP, 15 micronutrients (Vitamin A 400 µg, vitamin D 5 µg, vitamin E 5 mg, vitamin C 30 mg, thiamine 0.5 mg, riboflavin 0.5 mg, niacin 6 mg, pyridoxine 0.5 mg, vitamin B12 0.9 mg, folate 150 µg, iron 10 mg, zinc 4.1 mg, copper 0.56 mg, selenium 17.0 µg and iodine 90 µg). Daily supplementation for 24 weeks.

  • High zinc, low iron MNPDietary supplement

    Same as group 1, except with 10 mg zinc instead of 4.1 mg and 6 mg iron instead of 10 mg. Daily supplementation for 24 weeks.

  • High zinc, low/no iron on alternating daysDietary supplement

    Same as study group 1, except with 10 mg zinc instead of 4.1 mg, and 6 mg iron and no iron on alternating days instead of 10 mg. Daily supplementation for 24 weeks.

  • Dispersible zinc supplementDietary supplement

    10 mg zinc in a dispersible tablet. Daily supplementation for 24 weeks.

  • Intermittent zinc supplementDietary supplement

    10 mg zinc in a dispersible tablet. Daily supplementation for 14 days at baseline and 3 months, placebo tablet on all other days.

  • Placebo powderDietary supplement

    Daily provision of a placebo powder for 24 weeks.

Study groups in NCT03406793
Study groupRoleWhat they receive
1. Standard MNPExperimentalNot described
Receives: Dietary Supplement: Standard MNP
2. High zinc, low iron MNPExperimentalNot described
Receives: Dietary Supplement: High zinc, low iron MNP
3. High zinc, low/no ironExperimentalNot described
Receives: Dietary Supplement: High zinc, low/no iron on alternating days
4. Dispersible zinc supplementActive comparatorNot described
Receives: Dietary Supplement: Dispersible zinc supplement
5. Intermittent zinc supplementExperimentalNot described
Receives: Dietary Supplement: Intermittent zinc supplement
6. Placebo powderPlacebo comparatorNot described
Receives: Dietary Supplement: Placebo powder

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of diarrhea

    Incidence of diarrhea is defined as the number of diarrheal episodes per person-weeks of follow-up

    Measured: Incidence over the 24-week follow-up period

  2. Change in length-for-age Z score

    Change in length-for-age Z score from enrollment to the end of the 24-week follow-up period

    Measured: Measured at enrollment and the end of the 24-week follow-up period

Secondary outcomes (17)
  1. Change in stunting prevalence

    Change in the prevalence of stunting (LAZ <-2) in the study population over the 24-week follow-up period

    Measured: Measured at enrollment and the end of the 24-week follow-up period

  2. Change in wasting prevalence

    Change in the prevalence of wasting (WLZ <-2) in the study population over the 24-week follow-up period

    Measured: Measured at enrollment and at the end of the 24-week follow-up period

  3. Incidence of dysentery

    Dysentery is defined as any diarrheal episode in which the loose or watery stools contain visible red blood

    Measured: Measured twice weekly for 24 weeks

  4. Incidence of diarrhea with dehydration

    Incidence of diarrhea with dehydration over the 24-week follow-up period

    Measured: Measured twice weekly for 24 weeks

  5. Incidence of hospitalizations

    Hospitalization is defined as an overnight stay in the hospital due to illness

    Measured: Assessed twice weekly for 24 weeks

  6. Change in mean serum zinc concentration

    Change in mean serum zinc concentration among children in the biochemistry sub-group over the 24-week follow-up period

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants in all 6 intervention groups

  7. Change in the prevalence of zinc deficiency

    Change in the prevalence of zinc deficiency (serum zinc concentration <9.9 umol/L) in the biochemistry subgroup from baseline to the end of the 24-week follow-up period

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in subgroup of participants in all 6 intervention groups

  8. Change in the exchangeable zinc pool size

    Change in the exchangeable zinc pool size from enrollment to the end of the 24-week follow-up period in a subgroup of participants randomized to the high zinc, low-iron MNP group, dispersible zinc supplement group, and placebo group

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants randomized to the high zinc, low-iron MNP, dispersible zinc supplement, and placebo groups.

  9. Change in ferritin concentrations

    Change in mean concentrations of ferritin from enrollment to the end of the 24-week follow-up period among participants in the biochemistry subgroup.

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants in all 6 intervention groups

  10. Change in concentrations of soluble transferrin receptor

    Change in mean concentrations of soluble transferrin receptor from enrollment to the end of the 24-week follow-up period among participants in the biochemistry subgroup.

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants in all 6 intervention groups

  11. Change in gut microbiota

    Change in the composition of gut microbiota from enrollment to the end of the 24-week follow-up period among a subgroup of participants randomized to the high zinc, low-iron; dispersible zinc supplement; and placebo powder groups.

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants randomized to the high zinc, low-iron MNP, dispersible zinc supplement, and placebo groups.

  12. Change in amino acid metabolites associated with gut permeability

    To compare the change in amino acid metabolites associated with gut permeability from enrollment to the end of the 24-week follow-up period among a subgroup of participants randomized to the high zinc, low-iron MNP; dispersible zinc supplement; and placebo groups.

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants randomized to the high zinc, low-iron MNP, dispersible zinc supplement, and placebo groups.

  13. Change in lipid metabolites associated with gut permeability

    To compare the change in lipid metabolites associated with gut permeability from enrollment to the end of the 24-week follow-up period among a subgroup of participants randomized to the high zinc, low-iron MNP; dispersible zinc supplement; and placebo groups.

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants randomized to the high zinc, low-iron MNP, dispersible zinc supplement, and placebo groups.

  14. Change in genome wide gene expression by RNA-sequencing

    To compare the change in genome wide gene expression, measured with RNA-sequencing, from enrollment to the end of the 24-week follow-up period among a subgroup of participants randomized to the high zinc, low-iron MNP; dispersible zinc supplement; and placebo groups.

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants randomized to the high zinc, low-iron MNP, dispersible zinc supplement, and placebo groups.

  15. Change in specific gene expression by quantitative Polymerase Chain Reaction

    To compare the change in specific gene expression, measured by quantitative Polymerase Chain Reaction, from enrollment to the end of the 24-week follow-up period among a subgroup of participants randomized to the high zinc, low-iron MNP; dispersible zinc supplement; and placebo groups.

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants randomized to the high zinc, low-iron MNP, dispersible zinc supplement, and placebo groups.

  16. Change in cellular immune function by leukocyte profiles

    To compare the change in cellular immune function by leukocyte profiles, from enrollment to the end of the 24-week follow-up period among a subgroup of participants randomized to the high zinc, low-iron MNP; dispersible zinc supplement; and placebo groups.

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants randomized to the high zinc, low-iron MNP, dispersible zinc supplement, and placebo groups.

  17. Change in serum cytokines

    To compare the change in serum cytokines, measured by Luminex analysis, from enrollment to the end of the 24-week follow-up period among a subgroup of participants randomized to the high zinc, low-iron MNP; dispersible zinc supplement; and placebo groups.

    Measured: Measured at enrollment and at the end of the 24-week follow-up period in a subgroup of participants randomized to the high zinc, low-iron MNP, dispersible zinc supplement, and placebo groups.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Jan 2018
  2. Study start20 Feb 2018
  3. Primary completion12 Jan 2020
  4. Study completion12 Jan 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
2,886 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03406793
Sponsor's protocol ID
1.05
Status last verified
Oct 2020
First submitted
12 Jan 2018
Last updated
3 Nov 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Thompson L, Arnold C, Peerson J, Long JM, Westcott JLE, Islam MM, Black RE, Krebs NF, McDonald CM. Predictors of Anaemia Among Young Children Receiving Daily Micronutrient Powders (MNPs) for 24 Weeks in Bangladesh: A Secondary Analysis of the Zinc in Powders Trial. Matern Child Nutr. 2025 Jul;21(3):e13806. doi: 10.1111/mcn.13806. Epub 2025 Feb 10.

    PubMed 39925177
  • Islam MM, Black RE, Krebs NF, Westcott J, Long J, Islam KM, Peerson JM, Sthity RA, Khandaker AM, Hasan M, El Arifeen S, Ahmed T, King JC, McDonald CM. Different Doses, Forms, and Frequencies of Zinc Supplementation for the Prevention of Diarrhea and Promotion of Linear Growth among Young Bangladeshi Children: A Six-Arm, Randomized, Community-Based Efficacy Trial. J Nutr. 2022 May 5;152(5):1306-1315. doi: 10.1093/jn/nxab439.

    PubMed 35015856

Questions about this trial

What is this clinical trial studying?

A study testing Standard MNP, High zinc, low iron MNP and High zinc, low/no iron on alternating days in people with Diarrhea and Stunting, run by UCSF Benioff Children's Hospital Oakland at 1 site in Bangladesh.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Nov 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Bangladesh. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of diarrhea (time frame: Incidence over the 24-week follow-up period). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03406793, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Nov 2020.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in