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Total and resting energy expenditure in children with sickle cell disease
E M Barden1, B S Zemel, D A Kawchak
1Department of Anthropology, University of Pennsylvania, Philadelphia, USA.
Insights
Children with sickle cell disease (SCD) experience chronic energy deficiency due to elevated resting energy expenditure and lower activity energy expenditure, contributing to impaired growth. Further research is needed for effective treatment strategies.
Area of Science:
- Pediatric Endocrinology
- Nutritional Science
- Hematology
Background:
- Children with sickle cell disease (SCD) often exhibit impaired growth and undernutrition.
- Energy balance is a critical factor influencing growth and development in pediatric populations.
Purpose of the Study:
- To investigate energy balance in children with SCD.
- To determine if altered energy expenditure contributes to growth impairment and undernutrition in pediatric SCD.
Main Methods:
- Compared energy expenditure (resting, total, activity-related) and dietary intake in children with SCD and healthy controls.
- Utilized doubly labeled water technique for total energy expenditure (TEE) and indirect calorimetry for resting energy expenditure (REE).
- Calculated activity-related energy expenditure (AEE) as TEE minus REE; assessed fat-free mass (FFM).
Main Results:
- Children with SCD showed significantly increased REE (131 kcal/d) compared to controls, independent of sex and FFM.
- AEE was significantly lower in children with SCD (268 kcal/d), with a marginal decrease after adjusting for FFM and sex.
- While TEE tended to be lower in SCD, this difference was not significant after adjusting for FFM and sex.
Conclusions:
- Elevated REE and reduced AEE in children with SCD suggest a state of chronic energy deficiency.
- This chronic energy deficiency likely contributes to the observed poor growth status in pediatric SCD.
- Further research is essential to develop optimal treatment and prevention strategies for undernutrition in children with SCD.
Objective:
To investigate energy balance in children with sickle cell disease (SCD) as the possible cause of impaired growth and undernutrition.
Study Design:
Growth, resting (REE), total (TEE), and activity-related (AEE) energy expenditure and dietary intake were examined in 36 African American children with SCD (20 girls and 16 boys) and 30 control subjects (15 girls and 15 boys) of similar age (mean, 11.2 years) and ethnicity. TEE was measured by means of the doubly labeled water technique and REE by indirect calorimetry. AEE was calculated as TEE minus REE. Fat free mass (FFM) was calculated from skinfold prediction equations.
Results:
REE was significantly increased (131 kcal/d) in children with SCD (P =.001), after adjusting for sex and FFM. Children with SCD tended to have lower TEE (214 kcal/d) than control subjects, but there was no difference after adjusting for FFM and sex (P =.57). Children with SCD had significantly (P =.025) lower AEE (268 kcal/d) but only marginally (P =.08) lower AEE after adjusting for FFM and sex.
Conclusions:
The elevated REE and lower AEE, in combination with poor growth status, indicate chronic energy deficiency in children with SCD. Further studies are needed to determine the best approaches to the treatment and prevention of undernutrition in children with SCD.