{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:44:26Z","timestamp":1787888666803,"version":"build-2784847793"},"reference-count":82,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T00:00:00Z","timestamp":1626825600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T00:00:00Z","timestamp":1626825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Nationally representative population data on zinc status in Nepal is lacking at present. This study analyzed data from the recent Nepal National Micronutrient status survey 2016 to determine the prevalence of zinc deficiency and associated risk factors among children aged 6\u201359\u00a0months (n\u2009=\u20091462) and non-pregnant women aged 15\u201349\u00a0years (n\u2009=\u20091923). Venous blood was collected from the participants to measure micronutrients such as zinc, markers of anemia, RBP (vitamin A), and markers of inflammation. Stool samples were collected to assess soil-transmitted helminths and <jats:italic>Helicobacter pylori<\/jats:italic> infection. Socio-demographic, household, and other relevant factors were collected by a structured questionnaire. Serum zinc concentration was measured by Microwave Plasma Atomic Emission Spectrometry, and zinc deficiency was defined according to the International Zinc Nutrition Consultative Group\u2019s  guidelines. Logistic regression was used to examine the predictors of zinc deficiency among the participants. The overall zinc deficiency in children was 22.9%, while it was higher in non-pregnant women (24.7%). The prevalence of anemia among zinc-deficient children was higher (21.3%) than the zinc non-deficit children (18.7%). The prevalence of anemia was 18% among zinc-deficient non-pregnant women compared to 22% non-deficit non-pregnant women. Predictors associated with zinc deficiency among the study children were living in rural areas (AOR\u2009=\u20092.25, 95% CI, [1.13, 4.49]), the occurrence of diarrhea during the two weeks preceding the survey (AOR\u2009=\u20091.57, 95% CI, [1.07, 2.30]), lowest household wealth quintile (AOR\u2009=\u20090.48, 95% CI, [0.25, 0.92]) and lower vitamin A status (AOR\u2009=\u20090.49, 95% CI, [0.28, 0.85]. The predictors associated with zinc deficiency among non-pregnant women were: being underweight (AOR\u2009=\u20091.55, 95% CI, [1.12, 2.15]), fever occurrence during two weeks preceding the survey (AOR\u2009=\u20091.43, 95% CI, [1.04, 1.98]), <jats:italic>H. pylori<\/jats:italic> in the stool (AOR\u2009=\u20091.33, 95% CI, [1.04, 1.71]), lowest household wealth quintile (AOR\u2009=\u20090.62, 95% CI,[0.40, 0.94]) and being at risk of folate deficiency (AOR\u2009=\u20090.58, 95% CI,[0.36, 0.94]). We conclude that community-level intervention programs focused on rural children and women to prevent diarrhea, improve nutrition counseling, and provide economic opportunities in rural communities may help to lower zinc deficiency and other micronutrient deficiencies in the Nepalese population. We believe that intervention programs to address zinc deficiency should not be isolated. Instead, integrated approaches are beneficial to improve overall micronutrient status, such as encouraging dietary diversity, providing livelihood opportunities to the unemployed, micronutrient supplementation to vulnerable populations, and consumption of zinc-rich animal-based foods.<\/jats:p>","DOI":"10.1038\/s41598-021-94344-9","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T10:07:53Z","timestamp":1626862073000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Serum zinc status is a matter of concern among children and non-pregnant women in a nationwide survey of Nepal"],"prefix":"10.1038","volume":"11","author":[{"given":"Suresh","family":"Mehata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man Kumar","family":"Tamang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kedar Raj","family":"Parajuli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binod","family":"Rayamajhee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uday Narayan","family":"Yadav","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranju Kumari","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipendra Raman","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,21]]},"reference":[{"key":"94344_CR1","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.1186\/s12889-019-7979-3","volume":"19","author":"K Berhe","year":"2019","unstructured":"Berhe, K., Gebrearegay, F. & Gebremariam, H. Prevalence and associated factors of zinc deficiency among pregnant women and children in Ethiopia: A systematic review and meta-analysis. BMC Public Health 19, 1663. https:\/\/doi.org\/10.1186\/s12889-019-7979-3 (2019).","journal-title":"BMC Public Health"},{"key":"94344_CR2","volume-title":"The World Health Report 2002: Reducing Risks, Promoting Healthy Life","author":"World Health Organization","year":"2002","unstructured":"World Health Organization. The World Health Report 2002: Reducing Risks, Promoting Healthy Life (World Health Organization, 2002)."},{"key":"94344_CR3","doi-asserted-by":"publisher","first-page":"S403","DOI":"10.1177\/15648265070283S303","volume":"28","author":"SY Hess","year":"2007","unstructured":"Hess, S. Y., Peerson, J. M., King, J. C. & Brown, K. H. Use of serum zinc concentration as an indicator of population zinc status. Food Nutr. Bull. 28, S403-429. https:\/\/doi.org\/10.1177\/15648265070283S303 (2007).","journal-title":"Food Nutr. Bull."},{"key":"94344_CR4","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1093\/ajcn\/78.4.756","volume":"78","author":"C Hotz","year":"2003","unstructured":"Hotz, C., Peerson, J. M. & Brown, K. H. Suggested lower cutoffs of serum zinc concentrations for assessing zinc status: Reanalysis of the second National Health and Nutrition Examination Survey data (1976\u20131980). Am. J. Clin. Nutr. 78, 756\u2013764. https:\/\/doi.org\/10.1093\/ajcn\/78.4.756 (2003).","journal-title":"Am. J. Clin. Nutr."},{"key":"94344_CR5","doi-asserted-by":"publisher","first-page":"S99","DOI":"10.1177\/15648265040251S204","volume":"25","author":"KH Brown","year":"2004","unstructured":"Brown, K. H. et al. 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, S99-203 (2004).","journal-title":"Food Nutr. Bull."},{"key":"94344_CR6","unstructured":"kIZiNCG. Assessing population zinc status with serum zinc concentration. Technical Brief No.2, 2007. (2007)."},{"key":"94344_CR7","unstructured":"Ezzati, M., Lopez, A. D., Rodgers, A. A. & Murray, C. J. Comparative Quantification Of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. (World Health Organization, 2004)."},{"key":"94344_CR8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0050568","volume":"7","author":"KR Wessells","year":"2012","unstructured":"Wessells, K. R. & Brown, K. H. Estimating the global prevalence of zinc deficiency: Results based on zinc availability in national food supplies and the prevalence of stunting. PLoS ONE 7, e50568. https:\/\/doi.org\/10.1371\/journal.pone.0050568 (2012).","journal-title":"PLoS ONE"},{"key":"94344_CR9","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1111\/jhn.12791","volume":"33","author":"S Gupta","year":"2020","unstructured":"Gupta, S., Brazier, A. K. M. & Lowe, N. M. Zinc deficiency in low- and middle-income countries: prevalence and approaches for mitigation. J. Hum. Nutr. Diet. 33, 624\u2013643. https:\/\/doi.org\/10.1111\/jhn.12791 (2020).","journal-title":"J. Hum. Nutr. Diet."},{"key":"94344_CR10","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1093\/ajcn\/75.6.1062","volume":"75","author":"KH Brown","year":"2002","unstructured":"Brown, K. H., Peerson, J. M., Rivera, J. & Allen, L. H. Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: A meta-analysis of randomized controlled trials. Am. J. Clin. Nutr. 75, 1062\u20131071. https:\/\/doi.org\/10.1093\/ajcn\/75.6.1062 (2002).","journal-title":"Am. J. Clin. Nutr."},{"key":"94344_CR11","doi-asserted-by":"publisher","first-page":"1500S","DOI":"10.1093\/jn\/130.5.1500S","volume":"130","author":"RS MacDonald","year":"2000","unstructured":"MacDonald, R. S. The role of zinc in growth and cell proliferation. J. Nutr. 130, 1500S-1508S. https:\/\/doi.org\/10.1093\/jn\/130.5.1500S (2000).","journal-title":"J. Nutr."},{"key":"94344_CR12","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1093\/ajcn\/53.2.403","volume":"53","author":"AS Prasad","year":"1991","unstructured":"Prasad, A. S. Discovery of human zinc deficiency and studies in an experimental human model. Am J Clin Nutr 53, 403\u2013412. https:\/\/doi.org\/10.1093\/ajcn\/53.2.403 (1991).","journal-title":"Am J Clin Nutr"},{"key":"94344_CR13","doi-asserted-by":"publisher","first-page":"1334S","DOI":"10.1093\/ajcn\/71.5.1334s","volume":"71","author":"JC King","year":"2000","unstructured":"King, J. C. Determinants of maternal zinc status during pregnancy. Am. J. Clin. Nutr. 71, 1334S-1343S. https:\/\/doi.org\/10.1093\/ajcn\/71.5.1334s (2000).","journal-title":"Am. J. Clin. Nutr."},{"key":"94344_CR14","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/bf02829935","volume":"1","author":"ML Ackland","year":"2006","unstructured":"Ackland, M. L. & Michalczyk, A. Zinc deficiency and its inherited disorders: A review. Genes Nutr. 1, 41\u201349. https:\/\/doi.org\/10.1007\/bf02829935 (2006).","journal-title":"Genes Nutr."},{"key":"94344_CR15","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1089\/ars.2007.1893","volume":"10","author":"EL MacKenzie","year":"2008","unstructured":"MacKenzie, E. L., Iwasaki, K. & Tsuji, Y. Intracellular iron transport and storage: from molecular mechanisms to health implications. Antioxid. Redox Signal. 10, 997\u20131030. https:\/\/doi.org\/10.1089\/ars.2007.1893 (2008).","journal-title":"Antioxid. Redox Signal."},{"key":"94344_CR16","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1177\/0884533615570376","volume":"30","author":"C Livingstone","year":"2015","unstructured":"Livingstone, C. Zinc: Physiology, deficiency, and parenteral nutrition. Nutr. Clin. Pract. 30, 371\u2013382. https:\/\/doi.org\/10.1177\/0884533615570376 (2015).","journal-title":"Nutr. Clin. Pract."},{"key":"94344_CR17","doi-asserted-by":"publisher","first-page":"62","DOI":"10.3389\/fncel.2019.00062","volume":"13","author":"AM Adamo","year":"2019","unstructured":"Adamo, A. M. et al. Early developmental marginal zinc deficiency affects neurogenesis decreasing neuronal number and altering neuronal specification in the adult rat brain. Front. Cell. Neurosci. 13, 62. https:\/\/doi.org\/10.3389\/fncel.2019.00062 (2019).","journal-title":"Front. Cell. Neurosci."},{"key":"94344_CR18","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1111\/ped.13603","volume":"60","author":"HI Atasoy","year":"2018","unstructured":"Atasoy, H. I. & Bugdayci, G. Zinc deficiency and its predictive capacity for anemia: Unique model in school children. Pediatr. Int. 60, 703\u2013709. https:\/\/doi.org\/10.1111\/ped.13603 (2018).","journal-title":"Pediatr. Int."},{"key":"94344_CR19","unstructured":"Sigel, A., Sigel, H. & Sigel, R. K. O. in The Quarterly Review of Biology Vol. 90 352\u2013352 (The University of Chicago Press, 2015)."},{"key":"94344_CR20","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1542\/peds.108.6.1280","volume":"108","author":"S Sazawal","year":"2001","unstructured":"Sazawal, S. et al. Zinc supplementation in infants born small for gestational age reduces mortality: A prospective, randomized, controlled trial. Pediatrics 108, 1280\u20131286. https:\/\/doi.org\/10.1542\/peds.108.6.1280 (2001).","journal-title":"Pediatrics"},{"key":"94344_CR21","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1093\/ajcn\/72.6.1516","volume":"72","author":"ZA Bhutta","year":"2000","unstructured":"Bhutta, Z. A. et al. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: Pooled analysis of randomized controlled trials. Am. J. Clin. Nutr. 72, 1516\u20131522. https:\/\/doi.org\/10.1093\/ajcn\/72.6.1516 (2000).","journal-title":"Am. J. Clin. Nutr."},{"key":"94344_CR22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0191988","volume":"13","author":"PR Ghimire","year":"2018","unstructured":"Ghimire, P. R., Agho, K. E., Renzaho, A. M. N., Dibley, M. & Raynes-Greenow, C. Association between health service use and diarrhoea management approach among caregivers of under-five children in Nepal. PLoS ONE 13, e0191988. https:\/\/doi.org\/10.1371\/journal.pone.0191988 (2018).","journal-title":"PLoS ONE"},{"key":"94344_CR23","doi-asserted-by":"publisher","first-page":"34","DOI":"10.5530\/jppcm.2017.1.8","volume":"3","author":"K Alam","year":"2017","unstructured":"Alam, K., Poudel, A., Palaian, S., Koirala, B. & Shankar, P. R. Role of Zinc in childhood diarrhea management: A case of Nepal. J. Pharm. Pract. Commun. Med. 3, 34\u201336 (2017).","journal-title":"J. Pharm. Pract. Commun. Med."},{"key":"94344_CR24","unstructured":"National Planning Commission and Ministry of Health. Multi-Sector Nutrition Plan (2018\u20132022) (Kathmandu, Nepal, 2017)."},{"key":"94344_CR25","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/276469","volume":"2015","author":"S Bhandari","year":"2015","unstructured":"Bhandari, S. & Banjara, M. R. Micronutrients deficiency, a hidden hunger in Nepal: Prevalence, causes, consequences, and solutions. Int. Sch. Res. Not. 2015, 276469. https:\/\/doi.org\/10.1155\/2015\/276469 (2015).","journal-title":"Int. Sch. Res. Not."},{"key":"94344_CR26","unstructured":"UNICEF Nepal. <https:\/\/www.unicef.org\/nepal\/nutrition>"},{"key":"94344_CR27","unstructured":"Helen Keller International. ARCH (Assessment and Research on Child Feeding), <https:\/\/archnutrition.org\/where-we-work\/nepal\/>"},{"key":"94344_CR28","unstructured":"THE SUAAHARA II PROJECT: Improving health in Nepal, <https:\/\/borgenproject.org\/the-suaahara-ii-project\/> (2020)."},{"key":"94344_CR29","first-page":"156","volume":"10","author":"KR Sharma","year":"2012","unstructured":"Sharma, K. R. Malnutrition in children aged 6\u201359 months in Mugu district. J. Nepal Health Res. Counc. 10, 156\u2013159 (2012).","journal-title":"J. Nepal Health Res. Counc."},{"key":"94344_CR30","unstructured":"Ministry of Health Nepal, New ERA & ICF. Nepal Demographic and Health Survey 2016. (Ministry of Health, Nepal, Kathmandu, Nepal, 2017)."},{"key":"94344_CR31","doi-asserted-by":"crossref","unstructured":"Galetti, V. In Handbook of Famine, Starvation, and Nutrient Deprivation: From Biology to Policy (eds Victor Preedy & Vinood B. Patel) 1\u201323 (Springer International Publishing, 2018).","DOI":"10.1007\/978-3-319-40007-5_93-1"},{"key":"94344_CR32","unstructured":"Government of Nepal Ministry of Health and Population; UNICEF; USAID; European Union; CDC; New Era. Nepal National Micronutrient Status Survey 2016. (2018)."},{"key":"94344_CR33","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1093\/jn\/135.5.1106","volume":"135","author":"T Jiang","year":"2005","unstructured":"Jiang, T., Christian, P., Khatry, S. K., Wu, L. & West, K. P. Jr. Micronutrient deficiencies in early pregnancy are common, concurrent, and vary by season among rural Nepali pregnant women. J. Nutr. 135, 1106\u20131112. https:\/\/doi.org\/10.1093\/jn\/135.5.1106 (2005).","journal-title":"J. Nutr."},{"key":"94344_CR34","doi-asserted-by":"publisher","first-page":"594","DOI":"10.3945\/jn.108.102111","volume":"139","author":"RK Chandyo","year":"2009","unstructured":"Chandyo, R. K. et al. Zinc deficiency is common among healthy women of reproductive age in Bhaktapur, Nepal. J. Nutr. 139, 594\u2013597. https:\/\/doi.org\/10.3945\/jn.108.102111 (2009).","journal-title":"J. Nutr."},{"key":"94344_CR35","doi-asserted-by":"publisher","first-page":"1378S","DOI":"10.1093\/jn\/130.5.1378S","volume":"130","author":"B L\u00f6nnerdal","year":"2000","unstructured":"L\u00f6nnerdal, B. Dietary Factors Influencing Zinc Absorption. J. Nutr. 130, 1378S-1383S. https:\/\/doi.org\/10.1093\/jn\/130.5.1378S (2000).","journal-title":"J. Nutr."},{"key":"94344_CR36","doi-asserted-by":"publisher","first-page":"S480","DOI":"10.1177\/15648265070283s306","volume":"28","author":"B de Benoist","year":"2007","unstructured":"de Benoist, B., Darnton-Hill, I., Davidsson, L., Fontaine, O. & Hotz, C. Conclusions of the Joint WHO\/UNICEF\/IAEA\/IZiNCG interagency meeting on zinc status indicators. Food Nutr. Bull. 28, S480-484. https:\/\/doi.org\/10.1177\/15648265070283s306 (2007).","journal-title":"Food Nutr. Bull."},{"key":"94344_CR37","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/1756-0500-7-18","volume":"7","author":"AK Nepal","year":"2014","unstructured":"Nepal, A. K. et al. Plasma zinc levels, anthropometric and socio-demographic characteristics of school children in eastern Nepal. BMC. Res. Notes 7, 18\u201318. https:\/\/doi.org\/10.1186\/1756-0500-7-18 (2014).","journal-title":"BMC. Res. Notes"},{"key":"94344_CR38","unstructured":"IZiNCG. Assessing population zinc status with serum zinc concentration. Technical Brief. No.02. second edition. (2012)."},{"key":"94344_CR39","unstructured":"World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. WHO\/NMH\/NHD\/MNM\/11.1. (2017)."},{"key":"94344_CR40","doi-asserted-by":"publisher","first-page":"359s","DOI":"10.3945\/ajcn.116.141762","volume":"106","author":"SM Namaste","year":"2017","unstructured":"Namaste, S. M. et al. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am. J. Clin. Nutr. 106, 359s\u2013371s. https:\/\/doi.org\/10.3945\/ajcn.116.141762 (2017).","journal-title":"Am. J. Clin. Nutr."},{"key":"94344_CR41","unstructured":"World Health Organization. Serum and Red Blood Cell Folate Concentrations for Assessing Folate Status in Populations. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization. (2012)."},{"key":"94344_CR42","doi-asserted-by":"publisher","first-page":"468","DOI":"10.33314\/jnhrc.v17i4.2065","volume":"17","author":"MK Tamang","year":"2020","unstructured":"Tamang, M. K., Yadav, U. N., Acharya, A. & Lamsal, M. Assessment of zinc status among pregnant women attending a tertiary level hospital of Sunsari District, Nepal. J. Nepal Health Res. Counc. 17, 468\u2013473. https:\/\/doi.org\/10.33314\/jnhrc.v17i4.2065 (2020).","journal-title":"J. Nepal Health Res. Counc."},{"key":"94344_CR43","doi-asserted-by":"publisher","first-page":"306","DOI":"10.3390\/nu10030306","volume":"10","author":"L Daniels","year":"2018","unstructured":"Daniels, L. et al. Modifiable \u201cpredictors\u201d of zinc status in toddlers. Nutrients 10, 306. https:\/\/doi.org\/10.3390\/nu10030306 (2018).","journal-title":"Nutrients"},{"key":"94344_CR44","doi-asserted-by":"publisher","first-page":"21850","DOI":"10.1038\/srep21850","volume":"6","author":"H Yasuda","year":"2016","unstructured":"Yasuda, H. & Tsutsui, T. Infants and elderlies are susceptible to zinc deficiency. Sci. Rep. 6, 21850\u201321850. https:\/\/doi.org\/10.1038\/srep21850 (2016).","journal-title":"Sci. Rep."},{"key":"94344_CR45","doi-asserted-by":"publisher","first-page":"511","DOI":"10.4103\/ijmr.IJMR_1768_18","volume":"148","author":"Z Gonmei","year":"2018","unstructured":"Gonmei, Z. & Toteja, G. Micronutrient status of Indian population. Indian J. Med. Res. 148, 511\u2013521. https:\/\/doi.org\/10.4103\/ijmr.IJMR_1768_18 (2018).","journal-title":"Indian J. Med. Res."},{"key":"94344_CR46","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1007\/s12098-011-0379-z","volume":"78","author":"U Kapil","year":"2011","unstructured":"Kapil, U. & Jain, K. Magnitude of zinc deficiency amongst under five children in India. Indian J. Pediatr. 78, 1069\u20131072. https:\/\/doi.org\/10.1007\/s12098-011-0379-z (2011).","journal-title":"Indian J. Pediatr."},{"key":"94344_CR47","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.nut.2010.02.012","volume":"27","author":"KC Menon","year":"2011","unstructured":"Menon, K. C. et al. Concurrent micronutrient deficiencies are prevalent in nonpregnant rural and tribal women from central India. Nutrition 27, 496\u2013502. https:\/\/doi.org\/10.1016\/j.nut.2010.02.012 (2011).","journal-title":"Nutrition"},{"key":"94344_CR48","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1038\/ejcn.2017.127","volume":"71","author":"CD Karakochuk","year":"2017","unstructured":"Karakochuk, C. D. et al. The effect of inflammation on serum zinc concentrations and the prevalence estimates of population-level zinc status among Congolese children aged 6\u201359 months. Eur. J. Clin. Nutr. 71, 1467\u20131470. https:\/\/doi.org\/10.1038\/ejcn.2017.127 (2017).","journal-title":"Eur. J. Clin. Nutr."},{"key":"94344_CR49","doi-asserted-by":"publisher","first-page":"979","DOI":"10.3945\/jn.114.192336","volume":"144","author":"KJ Schulze","year":"2014","unstructured":"Schulze, K. J. et al. Micronutrient deficiencies are common in 6- to 8-year-old children of rural Nepal, with prevalence estimates modestly affected by inflammation. J. Nutr. 144, 979\u2013987. https:\/\/doi.org\/10.3945\/jn.114.192336 (2014).","journal-title":"J. Nutr."},{"key":"94344_CR50","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1093\/ajcn\/79.3.451","volume":"79","author":"TA Strand","year":"2004","unstructured":"Strand, T. A., Adhikari, R. K., Chandyo, R. K., Sharma, P. R. & Sommerfelt, H. Predictors of plasma zinc concentrations in children with acute diarrhea. Am. J. Clin. Nutr. 79, 451\u2013456. https:\/\/doi.org\/10.1093\/ajcn\/79.3.451 (2004).","journal-title":"Am. J. Clin. Nutr."},{"key":"94344_CR51","doi-asserted-by":"publisher","first-page":"e0146810","DOI":"10.1371\/journal.pone.0146810","volume":"11","author":"Y Martin-Prevel","year":"2016","unstructured":"Martin-Prevel, Y. et al. Biological status and dietary intakes of iron, zinc and vitamin a among women and preschool children in Rural Burkina Faso. PLoS ONE 11, e0146810\u2013e0146810. https:\/\/doi.org\/10.1371\/journal.pone.0146810 (2016).","journal-title":"PLoS ONE"},{"key":"94344_CR52","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1177\/0379572117715818","volume":"38","author":"R Harika","year":"2017","unstructured":"Harika, R. et al. Are Low Intakes and Deficiencies in Iron, Vitamin A, Zinc, and Iodine of Public Health Concern in Ethiopian, Kenyan, Nigerian, and South African Children and Adolescents?. Food Nutr Bull 38, 405\u2013427. https:\/\/doi.org\/10.1177\/0379572117715818 (2017).","journal-title":"Food Nutr Bull"},{"key":"94344_CR53","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s11130-010-0157-5","volume":"65","author":"A Gegios","year":"2010","unstructured":"Gegios, A. et al. Children consuming cassava as a staple food are at risk for inadequate zinc, iron, and vitamin A intake. Plant Foods Hum. Nutr. 65, 64\u201370. https:\/\/doi.org\/10.1007\/s11130-010-0157-5 (2010).","journal-title":"Plant Foods Hum. Nutr."},{"key":"94344_CR54","doi-asserted-by":"publisher","first-page":"2838","DOI":"10.1093\/jn\/130.11.2838","volume":"130","author":"J Ma","year":"2000","unstructured":"Ma, J. & Betts, N. M. Zinc and copper intakes and their major food sources for older adults in the 1994\u201396 continuing survey of food intakes by individuals (CSFII). J. Nutr. 130, 2838\u20132843. https:\/\/doi.org\/10.1093\/jn\/130.11.2838 (2000).","journal-title":"J. Nutr."},{"key":"94344_CR55","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s40795-015-0026-6","volume":"1","author":"G Kumera","year":"2015","unstructured":"Kumera, G. et al. Prevalence of zinc deficiency and its association with dietary, serum albumin and intestinal parasitic infection among pregnant women attending antenatal care at the University of Gondar Hospital, Gondar, Northwest Ethiopia. BMC Nutr. 1, 31. https:\/\/doi.org\/10.1186\/s40795-015-0026-6 (2015).","journal-title":"BMC Nutr."},{"key":"94344_CR56","unstructured":"Heifer International Nepal. Strengthing Smallholder Enterprises of Livestock Value Chain for Poverty Reduction and Economic Growth in Nepal II (SLVC II), <http:\/\/www.heifernepal.org\/Projects>"},{"key":"94344_CR57","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/s0022-3476(88)80627-9","volume":"113","author":"C Castillo-Duran","year":"1988","unstructured":"Castillo-Duran, C., Vial, P. & Uauy, R. Trace mineral balance during acute diarrhea in infants. J. Pediatr. 113, 452\u2013457. https:\/\/doi.org\/10.1016\/s0022-3476(88)80627-9 (1988).","journal-title":"J. Pediatr."},{"key":"94344_CR58","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005436.pub5","author":"M Lazzerini","year":"2016","unstructured":"Lazzerini, M. & Wanzira, H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst. Rev. https:\/\/doi.org\/10.1002\/14651858.CD005436.pub5 (2016).","journal-title":"Cochrane Database Syst. Rev."},{"key":"94344_CR59","doi-asserted-by":"publisher","first-page":"654","DOI":"10.3748\/wjg.v20.i3.654","volume":"20","author":"S Cardaropoli","year":"2014","unstructured":"Cardaropoli, S., Rolfo, A. & Todros, T. Helicobacter pylori and pregnancy-related disorders. World J. Gastroenterol. 20, 654\u2013664. https:\/\/doi.org\/10.3748\/wjg.v20.i3.654 (2014).","journal-title":"World J. Gastroenterol."},{"key":"94344_CR60","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1093\/gastro\/goy001","volume":"6","author":"S John","year":"2018","unstructured":"John, S., Baltodano, J. D., Mehta, N., Mark, K. & Murthy, U. Unexplained iron deficiency anemia: Does Helicobacter pylori have a role to play?. Gastroenterol. Rep. 6, 215\u2013220. https:\/\/doi.org\/10.1093\/gastro\/goy001 (2018).","journal-title":"Gastroenterol. Rep."},{"key":"94344_CR61","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1111\/j.1523-5378.2007.00476.x","volume":"12","author":"F Semp\u00e9rtegui","year":"2007","unstructured":"Semp\u00e9rtegui, F. et al. Low concentrations of zinc in gastric mucosa are associated with increased severity of Helicobacter pylori-induced inflammation. Helicobacter 12, 43\u201348. https:\/\/doi.org\/10.1111\/j.1523-5378.2007.00476.x (2007).","journal-title":"Helicobacter"},{"key":"94344_CR62","doi-asserted-by":"publisher","first-page":"2884","DOI":"10.1096\/fasebj.2.13.2458983","volume":"2","author":"RJ Cousins","year":"1988","unstructured":"Cousins, R. J. & Leinart, A. S. Tissue-specific regulation of zinc metabolism and metallothionein genes by interleukin 1. FASEB J. 2, 2884\u20132890. https:\/\/doi.org\/10.1096\/fasebj.2.13.2458983 (1988).","journal-title":"FASEB J."},{"key":"94344_CR63","doi-asserted-by":"publisher","first-page":"201","DOI":"10.4103\/1319-3767.54743","volume":"15","author":"BA Salih","year":"2009","unstructured":"Salih, B. A. Helicobacter pylori infection in developing countries: the burden for how long?. Saudi J. Gastroenterol. Off. J. Saudi Gastroenterol. Assoc. 15, 201\u2013207. https:\/\/doi.org\/10.4103\/1319-3767.54743 (2009).","journal-title":"Saudi J. Gastroenterol. Off. J. Saudi Gastroenterol. Assoc."},{"key":"94344_CR64","doi-asserted-by":"publisher","first-page":"7386","DOI":"10.4081\/pr.2019.7386","volume":"11","author":"L Rerksuppaphol","year":"2019","unstructured":"Rerksuppaphol, L. & Rerksuppaphol, S. Zinc deficiency in children with Dengue viral infection. Pediatric Rep. 11, 7386\u20137386. https:\/\/doi.org\/10.4081\/pr.2019.7386 (2019).","journal-title":"Pediatric Rep."},{"key":"94344_CR65","doi-asserted-by":"publisher","first-page":"624","DOI":"10.3390\/nu9060624","volume":"9","author":"NZ Gammoh","year":"2017","unstructured":"Gammoh, N. Z. & Rink, L. Zinc in Infection and Inflammation. Nutrients 9, 624. https:\/\/doi.org\/10.3390\/nu9060624 (2017).","journal-title":"Nutrients"},{"key":"94344_CR66","doi-asserted-by":"publisher","first-page":"1412S","DOI":"10.1093\/jn\/130.5.1412S","volume":"130","author":"ME Scott","year":"2000","unstructured":"Scott, M. E. & Koski, K. G. Zinc deficiency impairs immune responses against parasitic nematode infections at intestinal and systemic sites. J. Nutr. 130, 1412S-1420S. https:\/\/doi.org\/10.1093\/jn\/130.5.1412S (2000).","journal-title":"J. Nutr."},{"key":"94344_CR67","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.1038\/ejcn.2009.53","volume":"63","author":"JL Rosado","year":"2009","unstructured":"Rosado, J. L. et al. Interaction of zinc or vitamin A supplementation and specific parasite infections on Mexican infants\u2019 growth: A randomized clinical trial. Eur. J. Clin. Nutr. 63, 1176\u20131184. https:\/\/doi.org\/10.1038\/ejcn.2009.53 (2009).","journal-title":"Eur. J. Clin. Nutr."},{"key":"94344_CR68","first-page":"19","volume":"36","author":"F Curtale","year":"1994","unstructured":"Curtale, F., Vaidya, Y. & Tilden, R. L. Ascariasis, hookworm infection and serum retinol amongst children in Nepal. Panminerva Med. 36, 19\u201321 (1994).","journal-title":"Panminerva Med."},{"key":"94344_CR69","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/S0035-9203(03)90042-3","volume":"97","author":"A Olsen","year":"2003","unstructured":"Olsen, A. et al. Effects of multimicronutrient supplementation on helminth reinfection: a randomized, controlled trial in Kenyan schoolchildren. Trans. R. Soc. Trop. Med. Hyg. 97, 109\u2013114. https:\/\/doi.org\/10.1016\/S0035-9203(03)90042-3 (2003).","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"94344_CR70","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1093\/ajcn\/74.1.125","volume":"74","author":"M Hansen","year":"2001","unstructured":"Hansen, M. et al. Folic acid enrichment of bread does not appear to affect zinc absorption in young women. Am. J. Clin. Nutr. 74, 125\u2013129. https:\/\/doi.org\/10.1093\/ajcn\/74.1.125 (2001).","journal-title":"Am. J. Clin. Nutr."},{"key":"94344_CR71","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1093\/ajcn\/39.4.535","volume":"39","author":"DB Milne","year":"1984","unstructured":"Milne, D. B., Canfield, W. K., Mahalko, J. R. & Sandstead, H. H. Effect of oral folic acid supplements on zinc, copper, and iron absorption and excretion. Am. J. Clin Nutr 39, 535\u2013539. https:\/\/doi.org\/10.1093\/ajcn\/39.4.535 (1984).","journal-title":"Am. J. Clin Nutr"},{"key":"94344_CR72","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1093\/ajcn\/nqz304","volume":"111","author":"CM McDonald","year":"2020","unstructured":"McDonald, C. M. et al. Adjusting plasma or serum zinc concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am. J. Clin. Nutr. 111, 927\u2013937. https:\/\/doi.org\/10.1093\/ajcn\/nqz304 (2020).","journal-title":"Am. J. Clin. Nutr."},{"key":"94344_CR73","unstructured":"Gwatkin Davidson R et al. Socio-Economic Differences in Health, Nutrition, and Population. Country reports on HNP and Poverty. (World Bank Group, Washington DC, 2007)."},{"key":"94344_CR74","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.3945\/jn.114.191585","volume":"144","author":"KR Wessells","year":"2014","unstructured":"Wessells, K. R., King, J. C. & Brown, K. H. Development of a plasma zinc concentration cutoff to identify individuals with severe zinc deficiency based on results from adults undergoing experimental severe dietary zinc restriction and individuals with acrodermatitis enteropathica. J. Nutr. 144, 1204\u20131210. https:\/\/doi.org\/10.3945\/jn.114.191585 (2014).","journal-title":"J. Nutr."},{"key":"94344_CR75","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1385\/BTER:80:1:77","volume":"80","author":"R Forrer","year":"2001","unstructured":"Forrer, R., Gautschi, K. & Lutz, H. Simultaneous measurement of the trace elements Al, As, B, Be, Cd Co, Cu, Fe, Li, Mn, Mo, Ni, Rb, Se, Sr, and Zn in human serum and their reference ranges by ICP-MS. Biol. Trace Elem. Res. 80, 77\u201393 (2001).","journal-title":"Biol. Trace Elem. Res."},{"key":"94344_CR76","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1016\/j.clinbiochem.2017.04.006","volume":"50","author":"RD Whitehead Jr","year":"2017","unstructured":"Whitehead, R. D. Jr. et al. Effects of preanalytical factors on hemoglobin measurement: A comparison of two HemoCue\u00ae point-of-care analyzers. Clin. Biochem. 50, 513\u2013520. https:\/\/doi.org\/10.1016\/j.clinbiochem.2017.04.006 (2017).","journal-title":"Clin. Biochem."},{"key":"94344_CR77","unstructured":"World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, <(http:\/\/www.who.int\/vmnis\/indicators\/haemoglobin.pdf> (2011)."},{"key":"94344_CR78","first-page":"813","volume":"32","author":"HA Sayed","year":"2002","unstructured":"Sayed, H. A., El Ayyat, A. A., Sabry, H. Y. & Amer, N. M. Upgrading of Kato-Katz technique for diagnosis of S. mansoni infection in rural Egypt. J. Egypt Soc. Parasitol. 32, 813\u2013820 (2002).","journal-title":"J. Egypt Soc. Parasitol."},{"key":"94344_CR79","doi-asserted-by":"publisher","first-page":"3127","DOI":"10.1093\/jn\/134.11.3127","volume":"134","author":"JG Erhardt","year":"2004","unstructured":"Erhardt, J. G., Estes, J. E., Pfeiffer, C. M., Biesalski, H. K. & Craft, N. E. Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique. J. Nutr. 134, 3127\u20133132. https:\/\/doi.org\/10.1093\/jn\/134.11.3127 (2004).","journal-title":"J. Nutr."},{"key":"94344_CR80","doi-asserted-by":"publisher","first-page":"658S","DOI":"10.3945\/ajcn.110.005777","volume":"94","author":"SA Tanumihardjo","year":"2011","unstructured":"Tanumihardjo, S. A. Vitamin A: Biomarkers of nutrition for development. Am. J. Clin. Nutr. 94, 658S-665S. https:\/\/doi.org\/10.3945\/ajcn.110.005777 (2011).","journal-title":"Am. J. Clin. Nutr."},{"key":"94344_CR81","unstructured":"World Health Organization. Indicators for Assessing Vitamin A Deficiency and Their Application in Monitoring and Evaluating Intervention Programmes. WHO\/NUT\/96.10. (1996)."},{"key":"94344_CR82","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1136\/jcp.45.4.344","volume":"45","author":"S O'Broin","year":"1992","unstructured":"O\u2019Broin, S. & Kelleher, B. Microbiological assay on microtitre plates of folate in serum and red cells. J. Clin. Pathol. 45, 344\u2013347. https:\/\/doi.org\/10.1136\/jcp.45.4.344 (1992).","journal-title":"J. Clin. Pathol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-94344-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-94344-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-94344-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T11:38:33Z","timestamp":1670067513000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-94344-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,21]]},"references-count":82,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["94344"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-94344-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,21]]},"assertion":[{"value":"4 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"14904"}}