Pica in sickle cell disease: nutritional management and implications

Abstract

Background: Individuals with sickle cell disease (SCD) frequently experience nutritional disturbances, including deficiencies in essential micronutrients. Iron and zinc deficiency anemia has been specifically associated with pica, an atypical eating behavior. Aims: This systematic review aimed to characterize pica among individuals with SCD, focusing on potential nutritional causes. Methods: A comprehensive literature search was conducted across the MEDLINE (PubMed), Latin American and Caribbean Center on Health Sciences Information (Bireme), and Google Scholar databases from July 2017 to January 2024. Eligible articles included original observational studies, interventions, and case reports involving individuals with SCD across all age groups. Literature reviews, doctoral or master's theses, unrelated studies, and duplicate publications were excluded. Results: Ten studies were selected that described the occurrence of pica episodes in the SCD population and explored potential associated nutritional causes. The most prevalent genotype was Hb SS, with ages ranging from 2 to 23 years. Males were more predominant than females in the included studies. Approximately 51.05% of the studied population exhibited pica behavior. Some studies observed that children with pica behavior had low weight and/or height and abnormal laboratory test results. The most commonly consumed objects were paper, foam, fabric, dust, soil, clay, and rubber, although the quantity and frequency of object consumption were not reported in most studies. The most reported symptoms associated with pica behavior included abdominal pain, vomiting, constipation, vaso-occlusive events, dizziness, and fatigue. Clinical interventions in the studies were pain medication, intestinal cleansing, intestinal resection, intravenous hydration, antibiotic therapy, gastric "bezoar" removal, and cognitive-behavioral therapy. The majority of the studied population was monitored by health centers, with frequent return visits. In all studies, physicians were responsible for clinical care. Conclusion: A significant association between SCD and pica was evident in the reviewed studies. Iron and zinc deficiencies emerged as potential contributing factors to this atypical eating behavior. Keywords: Pica, sickle cell disease, iron, zinc, eating disorders.