Effect of Zinc Supplementation on Changes in Anthropometric Index of Toddler: A Meta-Analysis


  • Desif Upix Usmaningrum Master's Program in Public Health, Universitas Sebelas Maret
  • Bhisma Murti Master's Program in Public Health, Universitas Sebelas Maret
  • Eti Poncorini Pamungkasari Faculty of Medicine, Universitas Sebelas Maret




Background: Stunting occurs as a result of a long chain of malnutrition burden at every phase of life. Insufficient intake of protein energy in pregnancy and toddler growth has an impact on the risk of stunting under five. In addition, stunting is also considered to be closely related to deficiency of essential micronutrients, especially iron and zinc.

Subjects and Method: This research is a systematic review and meta-analysis study using PRISMA diagrams. The article search was conducted based on the eligibility criteria using the PICO Model. Population: Infants aged 0-59 months, Intervention: Zinc supplementation, Com­pa­ri­son: Placebo, Outcome: Anthropometric index of height for age (HAZ). The articles used were from PubMed, Google Scholar, Science Direct, and Scopus published from 2016 – 2022. The keywords used in the search were “zinc” AND “height” AND “infant” OR “toddler”. The inclusion criteria in this study were full paper articles with Randomized Control Trial, the intervention given was zinc with placebo comparison, research subjects were infants aged 0 – 59 months, and articles were published in English. The final results are presented in Standardized Mean Difference (SMD) in the analysis using the Revman 5.3 application.

Results: Meta-analysis was carried out on 10 articles originating from the continents of Asia, Africa, and America. The results of the analysis showed that zinc supplementation increased the anthropometric index (HAZ) with SMD=0.51 units higher than placebo and statistically significant (SMD=0.51, 95% CI=0.17 to 0.85; p=0.003).

Conclusion: The results of the meta-analysis showed that the administration of zinc supple­men­ta­tion increased the anthropometric index (HAZ) in children under five.

Keywords: zinc, anthropometry, height for age, toddler.

Correspondence: Desif Upix Usmaningrum. Master’s Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: desifupix@student.uns.ac.id. Mobile: +62878­38887228.


Almatsier S. (2009). Prinsip dasar ilmu gizi (basic principles of nutrition). Jakarta: Gramedia Pustaka Utama.

Barffour MA, Hinnouho GM, Kounnavong S, Wessells KR, Ratsavong K, Bounheuang B, Chanhthavong B, Sitthideth D, et al. (2019). 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: 207: 80-89.e2. doi: 10.1016/j.jpeds.2018.11.022. Epub 2018 Dec 21.

Becquey E, Ouédraogo CT, Hess SY, Rouamba N, Prince L, Ouédraogo JB, Vosti SA, Brown KH (2016). Comparison of Preventive and Therapeutic Zinc Supplementation in Young Children in Burkina Faso: A Cluster-Randomized, Community-Based Trial. J Nutr: 146(10): 2058-2066. doi: 10.3945/jn.116.230128.

Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J (2008). Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet: 371(9608): 243–260. https://doi.org/10.1016/S01406736(07)616900.

Brown KH, Rivera JA, Bhutta Z, Gibson RS, King JC, Lönnerdal B, Ruel MT, Sandtröm B, Wasantwisut E, Hotz C (2004). International zinc nutrition consultative group (IZiNCG) technical document #1. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull: 25(1 Suppl 2): S99-203.

Cho JM, Kim JY, Yang HR. 2019. Effects of oral zinc supplementation on zinc status and catch-up growth during the first 2 years of life in children with non-organic failure to thrive born preterm and at term. Pediatr Neonatol: 60(2): 201-209. doi: 10.1016/j.pedneo.2018.06.006.

Das JK, Salam RA, Kumar R, Bhutta ZA. (2013). Micronutrient fortification of food and its impact on woman and child health: a systematic review. Syst Rev: 23(2): 67. doi: 10.1186/20464053267.

Dewey KG, Begum K (2011). Long-term consequences of stunting in early life. Maternal Child Nutr: 7 (Suppl. 3): 5–18. doi: 10.1111/j.17408709.2011.00349.x

Cai-Jin Y, Jing-Ying S and Gang-Xi L. (2021). Meta-analysis of zinc deficiency and its influence factors in children under 14-year-old in china. J Fam Med: 8(5): 1257. doi.org/10.26420/jfammed.2021.1257.

Hayman T, Hickey P, Amann-Zalcenstein D, Bennett C, Ataide R, Sthity RA, et al (2021). Zinc supplementation with or without additional micronutrients does not affect peripheral blood gene expression or serum cytokine level in Bangladesh children. Nutrients: 13 (10):3516. https://doi.org/10.3390/nu13103516

Hidayat A (1999) Seng (zinc): esensial bagi kesehatan. Bagian Ilmu Kesehatan Masyarakat Fakultas Kedokteran Universitas Trisakti. J Kedokter Trisakti 18 (1): 19-26.

Hossain MI, Huq S, Ahmed T (2021). Changes in nutritional status and morbidities among children having severe acute malnutrition attending a nutrition follow-up unit in bangladesh who did not receive any food supplementation. Food Nutr Bull: 42(3): 399-405. doi: 10.1177/03795721211028545.

Howie S, Bottomley C, Chimah O, Ideh R, Ebruke B, Okomo U, et al. (2018). Zinc as an adjunct therapy in the management of severe pneumonia among Gambian children: randomized controlled trial. J Glob Health: 8(1): 010418. doi: 10.7189/jogh.08.010418.

Islam MM, Black RE, Krebs NF, Westcott J, Long J, Islam KM, Peerson JM, et al. (2022). Different doses, forms, and frequencies of zinc supplementation for the prevention of diarrhea and promotion of linear growth among young bangladeshi children: a sixarm, randomized, community-based efficacy trial. J Nutr: 152(5): 1306-1315. doi: 10.1093/jn/nxab439.

Kementerian Perencanaan dan Pembangunan Nasional/ Badan Perencanaan dan Pembangunan Nasional (2018). Pedoman pelaksanaan intervensi pe-nurunan stunting terintegrasi di kabupaten/ kota (Guidelines for implementing integrated stunting reduction interventions in districts/cities). Jakarta: Kementerian Perencanaan dan Pembangunan Nasional/ Badan Perenca-naan dan Pembangunan Nasional

Kiik MS, Nuwa MS (2020). Stunting dengan pendekatan framework WHO (stunting - using the WHO framework approach). Bantul: Gerbang Media Aksara.

Kusudaryati DPD, Muis SF, Widajanti L (2017). Pengaruh suplementasi Zn terhadap perubahan indeks TB/U anak stunted usia 24-36 bulan (Effect of Zn supplementation on changes in the TB/U index of stunted children aged 24-36 months). Jurnal Gizi Indonesia (The Indonesian Journal of Nutrition): 5(2): 98-104, doi: 10.14710/jgi.5.2.98104.

Lassi ZS, Kurji J, Oliveira CS, Moin A, Bhu-tta ZA (2020). Zinc supplementation for the promotion of growth and prevention of infections in infants less than six months of age. Cochrane Database Syst Rev: 4(4): CD010205. doi: 10.1002/14651858.

Locks LM, Manji KP, McDonald CM, Kupka R, Kisenge R, Aboud S, et al. (2015). Effect of zinc and multivitamin supplementation on the growth of Tanzanian children aged 6-84 wk: a randomized, placebo-controlled, double-blind trial. Am J Clin Nutr: 103(3): 910-8. doi: 10.3945/ajcn.115.120055.

Mann J, Truswell AS (2014). Buku Ajar Ilmu Gizi Edisi 4. Jakarta: EGC

Mayén VA, Ogunlusi A, Wright CM, Garcia AL (2021). Childhood stunting and micronutrient status unaffected by RCT of micronutrient fortified drink. Matern Child Nutr: 18:e13256. https://doi.org/10.1111/mcn.13256

Murti B (2018). Prinsip dan metode riset epidemiologi. v. Surakarta: Program Studi Ilmu Kesehatan Masyarakat.

Petry N, Olofin I, Boy E, Donahue Angel M, Rohner F (2016). The effect of low dose iron and zinc intake on child micronutrient status and development during the first 1000 days of life: a systematic review and meta-analysis. Nutrients: 8(12): 773. doi: 10.3390/nu8120773.

Platel K, Srinivasan K (2015). Bioavailability of micronutrients from plant foods: an update. critical reviews in food science and nutrition: 56(10): 1608-1619. Doi: 10.1080/10408398.2013.781011.

Purnamaningrum YE, Margono, Petphong V (2019). The effects of zinc and vitamin c supplementation on changes in height for age anthropometry index on stunting aged 24-59 months. Jurnal Kesehatan Ibu dan Anak. 13(1): 19-27.

Pusat Data dan Informasi Kemeterian Kesehatan RI. (2018). Situasi balita pendek (stunting) di Indonesia (The situation of stunted toddlers in Indonesia). Jakarta: Kementerian Kesehatan.

Salam RA, MacPhail C, Das JK, Bhutta ZA (2013) Effectiveness of micronutrient powders (MNP) in women and children. BMC Public Health: 13 (3): S22. doi: 10.1186/1471245813S3S22.

Soekirman (2000). Ilmu gizi dan aplikasinya untuk keluarga dan masyarakat (nutrition science and its applications for families and society). Jakarta: Direktorat Jenderal Pendidikan Tinggi, Departemen Pendidikan Nasional, pp: 80-125.

Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW (2013). Contextualizing complementary feeding in a broader framework for stunting prevention. Matern Child Nutr: 9(Suppl 2): 27-45. doi: 10.1111/mcn.12088.

Stipanuk MH, Caudill MA. (2013). Biochemical, physiological and molecular aspects of human nutrition. London: Saunders.

Sunguya BF, Zhu S, Mpembeni R, Huang J (2019). Trends in prevalence and determinants of stunting in Tanzania: an analysis of Tanzania demographic health surveys (1991–2016). Nutr J 18, 85. https://doi.org/10.1186/s1293701905058.

Vingstone C (2015). Zinc: Physiology, Deficiency, and Parenteral Nutrition. NCP: 30(3): 371-382. doi: 10.1177/0884533615570376.

Wahyuni LET (2021). Stunting dan 1000 HPK. Koran Jawa Pos Radar Banyuwangi.

Wessells KR, Brown KH (2012). Estimating the global prevalence of zinc deficiency: results based on zinc availability in national food supplies and the prevalence of stunting. PLoS One: 7(11): e50568. doi: 10.1371/journal.pone.0050568.

WHO (2006). WHO guidelines on food fortification with micronutrients. Geneva: World Health Organization.

Yuniastuti, Ari (2014). Nutrisi mikromineral dan kesehatan (micromineral nutrition and health). Semarang: UNNES Press.




How to Cite

Usmaningrum, D. U., Murti, B., & Pamungkasari, E. P. (2022). Effect of Zinc Supplementation on Changes in Anthropometric Index of Toddler: A Meta-Analysis. Journal of Maternal and Child Health, 7(5), 580–590. https://doi.org/10.26911/thejmch.2022.07.05.09