Influence of zinc supply on the course of infectious diarrhea in children of early age




zinc, children, viral infection, bacterial infection, diarrhea, risk factors


Aim. Give a comparative characteristic of the course of infectious diarrhea in young children, residents of the Zaporizhzhia region (Ukraine), depending on their provision of zinc (Zn).

Materials and methods. The study included 99 children aged 1 to 36 months with manifestations of infectious diarrhea. On the day of hospitalization, immunochromatographic and bacteriological examination of feces was performed. Also, on the first, third and fifth days of hospitalization, a general blood test and the level of Zn in the blood were determined for each patient.

Results. It was found that among the examined patients with infectious diarrhea at the onset of the disease, 22 children (22.2 %) had a reduced concentration of Zn in blood serum. In these children, the zinc level ranged from 7.63 to 9.17 μmol/l. It was also noted that the level of Zn in these patients on the 5th day of inpatient treatment rose to the norm of reference indicators. After studying the anamnesis, it was found that 40.9% of children with low Zn content had episodes of acute intestinal infection before this disease. During a comparative analysis of the clinical and laboratory data of patients, it was found that the tendency to more frequent vomiting occurred in patients with Zn deficiency (p = 0.05), that Zn availability had the most significant effect on the expressiveness of the diarrheal syndrome at the onset of the disease and more than a third (n = 8, 36.4 %) of children with Zn deficiency had more than 5 episodes of diarrhea per day, among which every second had more than 10. We did not determine significant differences between the frequency of viral and bacterial causes of diarrhea in the comparison groups. As for complete blood count, patients with Zn deficiency more often had a tendency to blood neutrophilia with a reliably frequent shift of the leukocyte formula to the left (p = 0.003). At the same time, children with a reduced content of Zn in blood serum significantly more often had lymphopenia at the onset of diarrheal disease (p = 0.006). When investigating the effect of Zn deficiency on the course of the disease, we found that in children with reduced Zn, the duration of diarrhea was almost twice as long (8 [6; 9] days vs. 5 [4; 6] in children with normal Zn indicators; p = 0.0001 according to the Mann–Whitney test) and in patients with infectious diarrhea who had Zn deficiency at the onset of the disease, on the seventh day of treatment diarrhea persisted significantly more often (p = 0.03). Such symptoms were accompanied by the persistence of signs of anemia (p = 0.06 on the 5th day) and a shift of the leukocyte formula to the left (p = 0.007) without leukocytosis.

Conclusions. Almost 25 % of young children with infectious diarrhea in the Zaporizhzhia region had Zn deficiency. Most likely, Zn deficiency is caused by the peculiarities of its supply with food and its metabolism. In the debut of a diarrheal disease, insufficient supply of Zn is associated with lymphopenia and a shift of the leukocyte formula to the left. Zn deficiency in infectious diarrhea leads to a long (more than 5 days) course of the disease due to prolongation of the diarrheal syndrome.

Author Biographies

V. V. Pechuhina, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

PhD student of the Department of Pediatric Infectious Diseases

O. V. Usachova, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Pediatric Infectious Diseases


Mokomane M, Kasvosve I, de Melo E, Pernica JM, Goldfarb DM. The global problem of childhood diarrhoeal diseases: emerging strategies in prevention and management. Ther Adv Infect Dis. 2018;5(1):29-43. doi:

Shankar S, Rosenbaum J. Chronic diarrhoea in children: A practical algorithm-based approach. J Paediatr Child Health. 2020;56(7):1029-38. doi:

Florez ID, Veroniki AA, Al Khalifah R, Yepes-Nuñez JJ, Sierra JM, Vernooij RW, et al. Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis. PLoS One. 2018;13(12):e0207701. doi:

Kramarov SO, Zakordonets LV. [Modern approaches to antibacterial therapy of acute intestinal infections]. Aktualna infektolohiia. 2018;6(3):119-23. Ukrainian. doi:

Krupko N. Infektsiina diareia: yak diahnostuvaty i likuvaty zghidno z dokazovymy danymy? [Infectious diarrhea: how to diagnose and treat according to evidence?]. Dytiachyi likar. 2018;2(59):48-60. Ukrainian.

Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 2014;59(1):132-52. doi:

Vorobiova NV, Usachova OV, Kaplaushenko AH. Pathogenetic role of intestinal microflora in carbohydrate malabsorption syndrome in early-aged children with rotavirus infection. Zaporozhye medical journal. 2021;23(5):683-90. doi:

Chernyshova LI, Teslenko MY, Radionova NM, Kasyan OI. [Clinical course of rotavirus gastroenteritis in children younger than 5 years in recent times]. Sovremennaya pediatriya. 2017; 4(84):96-100. Ukrainian. doi:

Ministry of Health of Ukraine. [Protocol for the treatment of acute intestinal infections in childrenOrder dated 2007 Dec 10 No. 803] [Internet]. 2007 [cited 2024 Feb 2]. Ukrainian. Available from:

Kramarov SO, Yevtushenko VV, Yevtushenko OM. [The value of zinc in infectious diseases in children]. Aktualna infektolohiia. 2020;8(1):17-24. Ukrainian. doi:

Eskander AE, Sherif LS, Nabih M, Baroudy NRE, Marcos GC, Badawy EA, Refay ASE. Serum Zinc Level and Its Correlation with Vesikari System Scoring in Acute Pediatric Diarrhea. Open Access Maced J Med Sci. 2017;5(5):677-80. doi:

Barffour MA, Hinnouho GM, Wessells KR, Kounnavong S, Ratsavong K, Sitthideth D, et al. Effects of therapeutic zinc supplementation for diarrhea and two preventive zinc supplementation regimens on the incidence and duration of diarrhea and acute respiratory tract infections in rural Laotian children: A randomized controlled trial. J Glob Health. 2020;10(1):010424. doi:

Rodríguez-Carmona Y, Denova-Gutiérrez E, Sánchez-Uribe E, Muñoz-Aguirre P, Flores M, Salmerón J. Zinc Supplementation and Fortification in Mexican Children. Food Nutr Bull. 2020;41(1):89-101. doi:

Wakana O, Toshiyuk IF. Roles of Zinc and Zinc Mediators in Immunity. Journal of Immunology Research. 2019:8396878. Available from:

Ohashi W, Fukada T. Contribution of Zinc and Zinc Transporters in the Pathogenesis of Inflammatory Bowel Diseases. J Immunol Res. 2019;2019:8396878. doi:

Teriv PS, Shkurupii DA. Defitsyt tsynku: aktsent na pytanniakh intensyvnoi terapii hostroi tserebralnoi nedostatnosti [Zinc deficiency: emphasis on issues of intensive care of acute cerebral insufficiency]. In: General theory of health and health care. Kharkiv: Publishing house Rozhko SH; 2017. p. 153-8. Ukrainian. Available from:

Maggini S, Pierre A, Calder PC. Immune Function and Micronutrient Requirements Change over the Life Course. Nutrients. 2018;10(10):1531. doi:

Gupta S, Brazier AKM, Lowe NM. Zinc deficiency in low- and middle-income countries: prevalence and approaches for mitigation. J Hum Nutr Diet. 2020;33(5):624-43. doi:

Abolurin OO, Oyelami OA, Oseni SB. A comparative study of the prevalence of zinc deficiency among children with acute diarrhoea in SouthWestern Nigeria. Afr Health Sci. 2020;20(1):406-12. doi:

Vreugdenhil M, Akkermans MD, van der Merwe LF, van Elburg RM, van Goudoever JB, Brus F. Prevalence of Zinc Deficiency in Healthy 1-3-Year-Old Children from Three Western European Countries. Nutrients. 2021 22;13(11):3713. doi:

Ehlayel MS, Bener A. Risk factors of zinc deficiency in children with atopic dermatitis. Eur Ann Allergy Clin Immunol. 2020;52(1):18-22. doi:

Wongteerasut A, Pranweerapaibul W. Does Serum Zinc Level Affect Severity of Acute Gastroenteritis Among Pre-School Thai Children? Pediatric Health Med Ther. 2021;12:481-9. doi:

Mahyar A, Ayazi P, Chegini V, Sahmani M, Oveisi S, Esmaeily S. Serum Zinc Concentrations in Children with Acute Bloody and Watery Diarrhoea. Sultan Qaboos Univ Med J. 2015;15(4):e512-6. doi:

Ikejiaku UP, Anochie I, Nwolisa EC, Iregbu FU, Amamilo IB. Serum Zinc Levels of Under Five Children with Diarrheal Disease. Journal of Advances in Medicine and Medical Research. 2020;32(24):1-10. doi:

Barffour MA, Hinnouho GM, Kounnavong S, Wessells KR, Ratsavong K, Bounheuang B, et al. Effects of Daily Zinc, Daily Multiple Micronutrient Powder, or Therapeutic Zinc Supplementation for Diarrhea Prevention on Physical Growth, Anemia, and Micronutrient Status in Rural Laotian Children: A Randomized Controlled Trial. J Pediatr. 2019;207:80-89.e2. doi:

Jeng SS, Chen YH. Association of Zinc with Anemia. Nutrients. 2022;14(22):4918. doi:

Chao HC. Zinc Deficiency and Therapeutic Value of Zinc Supplementation in Pediatric Gastrointestinal Diseases. Nutrients. 2023;15(19):4093. doi:



How to Cite

Pechuhina VV, Usachova OV. Influence of zinc supply on the course of infectious diarrhea in children of early age. Pathologia [Internet]. 2024Apr.22 [cited 2024Jul.18];21(1):77-83. Available from:



Original research