Feasibility trial for the management of severe acute malnutrition in older children with sickle cell anemia in Nigeria

Abstract

Children with sickle cell anemia (SCA) living in Nigeria are at an increased risk of malnutrition, which contributes to increased morbidity and mortality. However, evidence-based guidelines for managing malnutrition in children with SCA are lacking. To address this gap, we conducted a multicenter, randomized controlled feasibility trial to assess the feasibility and safety of treating children aged 5-12 years with SCA and uncomplicated severe acute malnutrition (body mass index z-score <-3). Children with SCA and uncomplicated severe acute malnutrition were randomly allocated to receive supplemental ready-to-use therapeutic food (RUTF) with or without moderate-dose hydroxyurea therapy (20 mg/kg/day). Over a six-month enrollment period, 3,190 children aged 5-12 years with SCA were evaluated for eligibility, and 110 of the 111 eligible children were enrolled. During the 12-week trial, no participants withdrew or missed visits. One participant died of unrelated causes. Adherence was high for hydroxyurea (94%), based on pill counts) and RUTF (100%, based on the number of empty sachets returned). No refeeding syndrome event or hydroxyurea-related myelosuppression occurred. At the end of the trial, the mean change in body mass index z-score was 0.49 (sd=0.53), and 39% of participants improved their body mass index z-score to >-3.0. Our findings demonstrate the feasibility, safety, and potential of outpatient treatment for uncomplicated severe acute malnutrition in children aged 5-12 years with SCA in a low-resource setting. However, RUTF sharing with household and community members potentially confounded the response to malnutrition treatment. This trial was registered at clinicaltrials.gov (#NCT03634488).

Impact of maternal depression on malnutrition treatment outcomes in older children with sickle cell anemia

“…The planned ancillary study was completed as a prospective cohort study within a randomized controlled feasibility trial for managing severe acute malnutrition in children with SCA conducted in Nigeria (SAMS trial, NCT03634488) [ 21 ]. The SAMS trial included participants aged 5–12 years old with laboratory-confirmed SCA (HbSS or HbS-beta 0 thalassemia) and uncomplicated severe acute malnutrition, as determined by a BMI z-score <-3.0 according to the World Health Organization growth reference [ 22 ].…”

Geriatric nutritional risk index predicts postoperative prognosis in older patients with hip fracture: A meta-analysis

“…[23] Anemia can also be a consequence of malnutrition, causing inadequate oxygen supply to the body and impairing muscle and bone function. [36,37] Malnutrition may reduce the function of the immune system, increasing susceptibility to infections and illness; this can lead to a decrease in muscle mass and bone density. [38] Overall, malnourished elderly individuals experience a decrease in physical strength and an unstable gait.…”

Malnutrition in sickle cell anemia: Prevalence, impact, and interventions: A Review

“…Medications commonly used to manage SCA, such as hydroxyurea, may have side effects that affect appetite and nutrient absorption, potentially contributing to malnutrition. [ 11 ]…”

“…Despite its evident significance, malnutrition often remains under-addressed in the clinical management of SCA. [11] This paper aims to fill this critical knowledge gap by presenting a comprehensive review of the prevalence and impact of malnutrition in individuals with SCA. Moreover, it delves into the existing nutritional interventions and strategies for alleviating malnutrition, thereby enhancing the holistic care and well-being of SCA patients.…”

“…Despite its evident significance, malnutrition often remains under-addressed in the clinical management of SCA. [ 11 ]…”