Factors Associated with Growth Retardation in Children Suffering from Sickle Cell Anemia: First Report from Central Africa

Abstract

Background. The aim of this study was to investigate and determine the risk factors associated with poor growth among SCA children. Methods. A cross-sectional study was conducted in Kinshasa, the capital's country. The nutritional status was assessed using the Z scores of the anthropometric indices. Results. We gathered data on the 256 patients, 138 females (53.9%), who entered the study. The mean age at presentation was 8.4 ± 4.9 years of age. Underweight, stunting, and wasting were found, respectively, in 47.7%, 10.5%, and 50.3% of SCA children. A history of hand-foot syndrome, more than 3 blood transfusions, being less than 12 months of age when receiving the first transfusion, more than two severe sickle crises per year, a medical history of severe infections, and the presence of hepatomegaly were associated with poor growth. When comparing sickle cell patients under 12 years of age (n = 159) to a group of 296 age-matched children with normal Hb-AA, a significantly higher proportion of subjects with stunting and underweight were found among SCA. Conclusion. Nutritional status encountered in Congolese sickle cell children has been described for the first time in this study. A high prevalence of poor growth in SCA children was found in our study.

Prevalence and correlates of growth failure in young African patients with sickle cell disease

“…In the studied population, living in West and Central Africa, more than half of patients with SS or Sb 0 phenotypes and more than one third of patients with SC or Sb + phenotypes suffered from growth failure. Growth failure was significantly more frequent in SS and Sb 0 phenotypes, whereas it was similar in SC, Sb + phenotypes and healthy subjects, as previously described in different countries (Platt et al, 1984;Stevens et al, 1986;Singhal et al, 1994;Chawla et al, 2013;Lukusa Kazadi et al, 2017). The greatest difference in growth failure frequency compared to non-SCD controls was observed during adolescence, between 12 and 18 years of age.…”

Osteopenia and Osteoporosis Assessed by Dual X Absorptiometry in Sickle Cell Anemia Adults Subjects

“…In the absence of normative size data for age (Kazadi et al, 2017) in our population, we could not verify the assertion regarding the significant relationships observed between BMD and low height for age, weight for age and BMI for age reported in several SCA studies (Henderson et al, 1994;Luban et al, 1982;Barden et al, 2000;Meeuwes et al, 2013;Bullamore et al, 1970;Lal et al, 2006;Miller et al, 2006;Baldanzi et al, 2011) but also between BMI and BMD in the general population (Kabeya et al, 2017).…”

“…Other studies have found no relationship between height or BMI and BMD (Chapelon et al, 2009;Lal A et al, 2006;Sarrai et al, 2006). The present study did not seek to evaluate the quantity and the quality of the food intake of our subjects who are considered weak (Kazadi et al, 2017), Therefore, we can not determine the contributions of calories, calcium, microelements or vitamin D in the disclose of low BMD.…”

“…This finding seems to be a phenomenon related to nutritional status, repeated infectious episodes and the metabolic status in SCA patients. A low BMI in SCA is richly documented in children and adults with SCA who have pre-and post-pubertal growth deficits and a weight at the 5th to 10th percentile of normal weight for age in some studies (Kazadi et al, 2017;Henderson et al, 1994;Aloni et al, 2014;Finkelstien et al, 1996). Kazadi et al (2017) and Platt et al (1984) reported stunting, impaired body composition, delayed skeletal and sexual maturation, and chronic nutritional deficiencies in children with SCA resulting in errors when WHO or American population growth curves are used (Chawla et al, 2013;Kazadi et al, 2017;Muchanga et al, 2014;Reed et al, 1987;WHO, 2006).…”

“…The majority of these studies were conducted out of sub-Saharan Africa, and, despite a relatively different biological, genotypic and phenotypic profile, the Congolese SCA clinical profile reflects an equivalent impact of this hemoglobinopathy on the bone system, suggesting the presence of remodeling abnormalities in the setting of low bone mass (Kabeya et al, 2017;Kazadi et al, 2017;Tshilolo et al, 2012;Platt et al, 1984).…”