ABSTRACT BACKGROUND/OBJECTIVES Population zinc (Zn) status assessment is based on serum zinc concentration (SZC) cut-offs defined by the International Zinc Nutrition Consultative Group

(IZiNCG). The objective of this study is to derive reference SZC cut-offs in apparently healthy 1-19 year Indian children and adolescents using comprehensive national nutrition survey (CNNS)

data, and to measure the prevalence of Zn deficiency. SUBJECTS/METHODS Apparently healthy children (_n_ = 12,473) were selected from the CNNS, by including the highest 2 wealth quintiles,

and excluding stunted, thin and obese children, and those with CRP > 5 mg/L, anaemia, hypo-albuminemia, diabetes, recent diarrhoea and history of smoking. The 2.5th centile of age-based

lower than with the IZiNCG cut-offs. No geographical state, nor any age group, had Zn deficiency as a serious public health problem (≥20%). In contrast, with IZiNCG cut-offs, 9-27 states

(depending on age group) had a public health problem. CONCLUSIONS The present study reference SZC cut-offs for Zn deficiency are lower than the IZiNCG cut-offs, and their rigorous selection

from a national sample makes them more appropriate for use in India. A re-examination of the global applicability of IZiNCG recommended cut-offs in other LMICs appears appropriate. Access

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SIMILAR CONTENT BEING VIEWED BY OTHERS SERUM ZINC STATUS IS A MATTER OF CONCERN AMONG CHILDREN AND NON-PREGNANT WOMEN IN A NATIONWIDE SURVEY OF NEPAL Article Open access 21 July 2021 VITAMIN

D STATUS AND DETERMINANTS IN INDIAN CHILDREN AND ADOLESCENTS: A MULTICENTRE STUDY Article Open access 06 October 2022 SOCIODEMOGRAPHIC DISPARITY IN THE NUTRITIONAL STATUS AMONG CHILDREN AND

ADOLESCENTS IN ZHEJIANG PROVINCE Article 19 August 2020 DATA AVAILABILITY The Ministry of Health and Family Welfare (MoHFW), Government of India, owns the CNNS data. CHANGE HISTORY * _ 06

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https://doi.org/10.1007/s12011-010-8758-2 Article  CAS  PubMed  Google Scholar  Download references ACKNOWLEDGEMENTS HSS and AVK are recipients of the Wellcome Trust/Department of

Biotechnology India Alliance Clinical/Public Health Research Centre Grant # IA/CRC/19/1/610006. RP, BK, GBR, and HR are supported by the Indian Council of Medical Research, Govt of India.

AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India Raghu Pullakhandam, Bharati Kulkarni, G. Bhanuprakash

Reddy & Hemalatha Rajkumar * St John’s Medical College, Bangalore, India Santu Ghosh & Anura V. Kurpad * Institute of Liver and Biliary Sciences, New Delhi, India Umesh Kapil *

Ministry of Health and Family Welfare, New Delhi, India Sila Deb * Sitaram Bhartia Institute of Science and Research, New Delhi, India Harshpal S. Sachdev Authors * Raghu Pullakhandam View

author publications You can also search for this author inPubMed Google Scholar * Santu Ghosh View author publications You can also search for this author inPubMed Google Scholar * Bharati

Kulkarni View author publications You can also search for this author inPubMed Google Scholar * G. Bhanuprakash Reddy View author publications You can also search for this author inPubMed 

Google Scholar * Hemalatha Rajkumar View author publications You can also search for this author inPubMed Google Scholar * Umesh Kapil View author publications You can also search for this

author inPubMed Google Scholar * Sila Deb View author publications You can also search for this author inPubMed Google Scholar * Anura V. Kurpad View author publications You can also search

for this author inPubMed Google Scholar * Harshpal S. Sachdev View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS HSS, AVK, SG, and RP

conceptualized the manuscript, and RP wrote the first draft and revised under the supervision of HSS and AVK. SG led the statistical analysis with guidance from HSS and AVK. HSS, AVK, RP,

SG, BK, GBR and HR contributed to the data interpretation and had access to all the data. All authors reviewed and approved the submitted manuscript. HSS and AVK had final responsibility for

the decision to submit for publication. CORRESPONDING AUTHORS Correspondence to Anura V. Kurpad or Harshpal S. Sachdev. ETHICS DECLARATIONS COMPETING INTERESTS HSS designed the draft

protocol of the CNNS with consultancy support from UNICEF, India. HSS, UK, and AVK were members of the Technical Advisory Committee of the CNNS, constituted by the Ministry of Health and

Family Welfare of the Government of India, to oversee its conduct and analysis. HSS is a member of the WHO Nutrition Guidance Expert Advisory Subgroup on Diet and Health and Guideline

Development Group on the use and interpretation of haemoglobin concentrations for assessing anaemia status in individuals and populations, member of the World Health Organization Nutrition

Guidance Expert Advisory Subgroup on Diet and Health and Expert group on nutrient requirements: setting calcium, vitamin D and Zn nutrient intake values for children aged 0-4 years. He is

also member of Expert Groups of the Ministry of Health and Family Welfare on Nutrition and Child Health. SD was involved in the CNNS study implementation. There were no other conflicts to

declare. The views expressed here by the authors are in their individual capacity and should not be construed as views or recommendations of the institutions the authors belong to. ETHICAL

APPROVAL The CNNS was conducted after obtaining due International Ethical approval from the Population Council’s International Review Board, New York, USA and National Ethical approval from

Post Graduate Institute of Medical Education and Research, Chandigarh, India (Ref. 14). ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional

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Pullakhandam, R., Ghosh, S., Kulkarni, B. _et al._ Reference cut-offs to define low serum zinc concentrations in healthy 1–19 year old Indian children and adolescents. _Eur J Clin Nutr_ 76,

1150–1157 (2022). https://doi.org/10.1038/s41430-022-01088-4 Download citation * Received: 29 October 2021 * Revised: 18 January 2022 * Accepted: 21 January 2022 * Published: 09 February

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