Study Describes Nutritional, Growth Deficits in Pediatric Sickle Cell Patients

April 11, 2021
Jonathan Alicea

Compared with controls, children and adolescents with sickle cell anemia were more likely to be underweight and exhibit signs of stunting and wasting.

A new study from Iraq has described the nutritional status and growth of pediatric patients with sickle cell anemia (SCA). More specifically, the study investigators observed poor growth and impacts on weight and height curves.

Led by Raad Sami Fahdil, Basra Teaching Hospital, the team conducted a case-control study in children and adolescents who visited the Center for Hereditary Blood Diseases at Basra Maternity and Children’s Hospital.

“Despite advances in our understanding of the molecular and genetic bases of SCA, little progress has been achieved in understanding the nutritional problems faced by children with SCA,” Fahdil and colleagues noted.

The Study

The investigators gathered detailed histories, including sociodemographic and clinical data, from 168 sickle cell patients. The team also conducted complete examinations for all patients and controls (n = 181).

“Exclusion criteria were a Glucose -6- Phosphate Dehydrogenase (G6PD) deficiency, hydroxyurea and zinc supplementation, a history of overt stroke, chronic medical or orthopaedic problems, fever or painful crises during the last 4 weeks, and blood transfusions within the last three months,” they wrote.

Severity of sickle cell disease was measured according to the frequency of vaso-occlusive crises, hospital admissions, and blood transfusions, and Z-scores for weight-for-age (WAZ), height-for-age (HAZ), and BMI for age (BMIZ) were calculated for all participants.

The latter measurements were then compared with the World Health Organization (WHO) Muticentre Growth Reference Study.

Fahdil’s team defined underweight, stunting, and wasting as WAZ, HAZ, and BMIZ scores < -2 standard deviations from the median WHO Child Growth Standard. A score > -3 was considered severe.

The Results

Overall, underweight was detected in 13.55% of sickle cell patients—compared with 2.6% in the control group.

Stunting and wasting were detected in 25.25% and 12.5%, respectively, in the patient population—versus 2.75% and 2.20%, respectively, in the controls (P<.05).

However, 8.33% of patients and 7.18% of controls were considered overweight or obese .

As for the experiences of the sickle cell population, 143 patients had experienced one or more vaso-occlusive crises during the past year, and 93 required hospitalization. Further, 65 required hospitalization fewer than 3 times last year, and 94 did not require blood transfusions.

According to low serum ferritin levels, no patient had iron-deficient anemia, while 64 had levels > 1000 ng/mL

Although the growth of patients in both groups was comparable at early ages, later ages were marked by increasing discrepancies. For example, the weight curve at 6-7 years of age in females and 9-10 years in males was significantly reduced among patients with SCA when compared with the control group (P<0.05)

Even more, the height curve began to decrease significantly at ages 8-9 years in males and ≥ 11 years in females in the sickle cell population.

“A logistic regression analysis of potential risk factors for stunting and wasting revealed significant positive correlations between the number of hospitalisations with wasting and both age and [C- reactive protein] CRP levels with stunting adversely affected the nutritional status of these patient,” the investigators noted.

Hemoglobin level was not considered an independent risk factor for malnutrion.

The team pointed out that numerous factors may affect pediatric growth, such as lower socioeconomic status—a typical risk factor for those affected by sickle cell disease. 

Although additional research in this domain is warranted, they suggested that nutritional interventions, regular health care visits, and growth monitoring may help optimize the growth and general health status of pediatric patients with sickle cell.

The study, “Growth and Nutritional Status of Children and Adolescents with Sickle Cell Anemia,” was published online in ResearchGate.