Dietary intakes and nutritional status of children with sickle cell disease at the Princess Marie Louise Hospital, Accra – a survey

Abstract Background: Sickle cell disease (SCD), an inherited blood disorder, predominantly affects individuals in sub-Saharan Africa. While there are established studies that links its pathophysiology and nutritional status, the extent of research in this area involving African patients has not been previously described. This systematic review aimed to assess the nutrition-focused landscape of SCD studies in Africa, summarize findings, and highlight gaps in knowledge that could inform priority-setting for future research.Methods: The study was conducted using the Preferred Reporting items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We included all original studies, conducted between 1995 and 2018, on nutritional status of individuals with SCD in Africa. ‘Nutritional status’ was defined by studies on dietary intake, measurements of growth/anthropometry, and nutritional biomarkers. Studies of anemia in non-SCD individuals and those with sickle cell traits were excluded. Databases used were Ovid Embase, Medline, Biosis and Web of Science. Results: The search returned 366 articles from which 62 studies were included in the final analyses. Seventy percent of the investigations were conducted in Nigeria. Studies were categorized into one of three main categories: descriptive studies of anthropometric characteristics (50%), descriptive studies of macro- or micronutrient levels (35%), and interventional studies (15%). Findings consistently found growth impairment, especially among children and adolescents. Studies assessing macro- and micro-nutrients generally had small sample sizes and were exploratory in nature. Only two randomized placebo-controlled trials were identified, which measured the impact of fatty acid supplementation and lime juice on health outcomes. Conclusions: The findings reveal a moderate number of descriptive studies, with small sample size, that focused on various aspects of nutrition and sickle cell disease in African patients. There was a stark lack of interventional studies that could be used to inform evidence-based changes in clinical practice. Findings of investigations were generally consistent with data from other regional settings, describing a significant risk of growth faltering and malnutrition among individuals with SCD. There is an unmet need for clinical research to better understand the potential benefits of nutritional-related interventions for patients with SCD in sub-Saharan Africa in order to promote optimal growth and improve health outcomes.

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Association of sickle cell disease with nutritional status among under-five children and mediating role of hemoglobin level: secondary analysis of data from 2018 Nigeria Demographic and Health Survey

10.21203/rs.3.rs-57486/v1 ◽

2020 ◽

Author(s):

Mohammad Redwanul Islam ◽

Md. Moinuddin ◽

Ayeda Ahmed ◽

Syed Moshfiqur Rahman

Keyword(s):

Sickle Cell Disease ◽

Nutritional Status ◽

Sickle Cell ◽

Hemoglobin Level ◽

Cell Disease ◽

Anthropometric Indices ◽

Under Five ◽

Under Five Children ◽

Mediating Role

Abstract Background: Malnutrition continues to affect under-five children in Africa to an overwhelming proportion. The situation is further compounded by the burden of sickle cell disease (SCD). However, association of SCD with stunting, wasting, and underweight in a nationally representative sample of under-five children remains unexplored. We aimed to describe prevalence of undernutrition by sickle cell status, to evaluate its association with growth faltering ascertained with anthropometric indices, and to explore mediating role of hemoglobin.Methods: We availed data from the 2018 Nigeria Demographic and Health Survey (DHS) and the sample comprised 11233 children aged 6–59 months who were successfully genotyped for SCD. The DHS employed a two-stage stratified sampling strategy. SickleSCAN rapid diagnostic test was used for SCD genotyping. Z-scores of length/height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ) were computed against the 2006 World Health Organization Child Growth Standards. We fitted logistic regression models to evaluate association of SCD with stunting, wasting, and underweight. Mediation analysis was performed to capture the indirect effect of, and proportion of total effect mediated through hemoglobin level in SCD-anthropometric indices association.Results: Prevalences of stunting, wasting, and underweight among children with SCD were 55.4% (54.5–56.4), 9.1% (8.6–9.7), and 38.9% (38.0-39.8), respectively. The odds of stunting were 2.39 times higher (adjusted odds ratio (aOR) 2.39, 95% CI: 1.26–4.54) among sickle children than those with normal hemoglobin. SCD was also significantly associated with underweight (aOR 2.64, 95% CI: 1.25–5.98), but not with wasting (aOR 1.60, 95% CI: 0.85–3.02). Hemoglobin level significantly mediated SCD-HAZ (adjusted indirect effect (aIE) -0.328, 95% CI: -0.387, -0.270), SCD-WHZ (aIE − 0.080, 95% CI: -0.114, -0.050), and WAZ (aIE − 0.245, 95% CI: -0.291, -0.200) associations. The extent of mediation was highest for SCD-HAZ association (adjusted proportion mediated 0.928, 95% CI: 0.535–2.770).Conclusion: We presented compelling evidence of the negative impact of SCD on nutritional status of under-five children. Integration of a nutrition-oriented approach into a definitive SCD care package and its nation-wide implementation could bring promising results by mitigating the nutritional vulnerability of children with SCD.

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Brief Report: Parent Perspectives of Nutritional Status and Mealtime Behaviors in Children with Sickle Cell Disease

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsh033 ◽

2004 ◽

Vol 29 (4) ◽

pp. 315-320 ◽

Cited By ~ 7

Author(s):

M. J. Mitchell

Keyword(s):

Sickle Cell Disease ◽

Nutritional Status ◽

Sickle Cell ◽

Parent Perspectives ◽

Cell Disease

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Nutritional Perspectives On Sickle Cell Disease In Africa: A Systematic Review

10.21203/rs.3.rs-20049/v1 ◽

2020 ◽

Author(s):

Eunice Berko Nartey ◽

Jonathan Spector ◽

Seth Adu-Afarwuah ◽

Catherine L. Jones ◽

Alan A. Jackson ◽

...

Keyword(s):

Systematic Review ◽

Sickle Cell Disease ◽

Nutritional Status ◽

Health Outcomes ◽

Sickle Cell ◽

Small Sample ◽

Sub Saharan Africa ◽

Cell Disease ◽

Sub Saharan ◽

The Impact

Abstract Background Sickle Cell Disease (SCD) is an inherited blood disorder and mostly affects individuals living in sub-Saharan Africa. Whilst there is an established link between its pathophysiology and nutritional status, research in this area in Africa is limited and evidence-based nutritional guidelines lacking. This systematic review aimed to evaluate studies in sub-Saharan Africa focused on nutritional aspects of SCD, codify results, and highlight gaps in knowledge that could inform priority-setting for future research. Methods The study was conducted using the Preferred Reporting items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We sought to include all studies involving original research of nutritional status of individuals (children and adults) with SCD in Africa. ‘Nutritional status’ was defined as topics related to dietary intake, measurements of growth or anthropometry, and nutritional-related biomarkers. Studies of anemia alone in non-SCD individuals were excluded as well as studies that assessed individuals with sickle cell trait (i.e., carriers). The databases used were Ovid Embase, Medline, Biosis and Web of Science. Studies conducted between 1995 and 2018 were included in the analyses. Results The search returned 366 articles from which 66 studies were included in the final analyses. Most investigations (70%) were conducted in Nigeria. Studies were categorized into one of three main categories: descriptive studies of anthropometric characteristics (47% of studies), descriptive studies of macro- or micronutrient levels (36% of studies), and interventional studies (14% of studies). There were fairly uniform findings that demonstrate that the growth of SCD patients in sub-Saharan Africa was impaired, especially in childhood and adolescence. Studies assessing macro- and micro-nutrients generally had small sample sizes and were exploratory in nature. Only two randomized, placebo-controlled trials were identified, which measured the impact of fatty acid supplementation and lime juice on health outcomes. Conclusions The findings of this review are consistent with data from other regional settings that describe a significant risk of malnutrition in individuals with SCD. There appears to be a substantial unmet need for clinical research to better understand the potential utility of nutritional-related interventions for patients with SCD in sub-Saharan Africa, to promote optimal growth and improve health outcomes.

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