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Characterization of pica prevalence among patients with sickle cell disease
N S Ivascu1, S Sarnaik, J McCrae
1Sickle Cell Center, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA.
Insights
Pica, the compulsive eating of non-food items, is common in children with sickle cell disease (SCD). This condition often correlates with lower hemoglobin levels and reduced body weight, suggesting potential nutritional links.
Area of Science:
- Hematology
- Pediatric Medicine
- Nutritional Science
Background:
- Sickle cell disease (SCD) is a genetic blood disorder with significant health implications.
- Pica, the persistent eating of non-nutritive substances, is a recognized but not fully understood phenomenon in various populations.
- The relationship between SCD and pica requires further investigation to understand its prevalence and contributing factors.
Purpose of the Study:
- To investigate the prevalence and characteristics of pica in pediatric patients diagnosed with sickle cell disease.
- To explore potential correlations between pica and specific disease parameters in children with SCD.
Main Methods:
- A retrospective, observational study was conducted.
- Medical records of 395 children with sickle cell disease (SCD) treated at an urban ambulatory care center were analyzed.
- Data collected included patient demographics, sickle cell genotype, pica history, hemoglobin levels, and nutritional markers.
Main Results:
- Pica was reported in 33.9% of the study population, with paper, foam, and powders being common ingested items.
- A higher prevalence of pica was observed in patients with Hb SS (sickle cell anemia) compared to other SCD genotypes.
- Patients with pica exhibited significantly lower mean hemoglobin levels, higher reticulocyte counts, and lower body weight compared to those without pica.
Conclusions:
- Pica occurs with high frequency in children with sickle cell disease, often associated with lower hemoglobin levels.
- The observed association between pica and low body weight suggests a potential nutritional influence on its prevalence.
- Further research is needed to determine if pica is a marker of SCD severity, as no link to increased hospitalizations was found.
Objective:
To determine the prevalence of pica and its characteristics among children with sickle cell disease.
Design:
Retrospective, observational study.
Setting:
An urban, ambulatory care, interdisciplinary center.
Patients:
The medical records of all 480 patients who visited the center from March 1, 1998, to June 30, 1999, were reviewed. Patients were excluded for history of stroke, long-term transfusions, pregnancy, acute illness, or age younger than 3 years.
Main Outcome Measures:
Sex, age, weight, height, Tanner stage, complete blood cell count, sickle cell genotype, pica history, and levels of iron, zinc, lead, and fetal hemoglobin (Hb).
Results:
Of 395 study patients, 134 (33.9%) reported pica. Ingested items included paper, foam, and powders. There was a significantly higher prevalence of pica among patients homozygous for Hb S (Hb SS, sickle cell anemia) compared with the combined group of double heterozygous patients with Hb SC, Hb SD, and Hb Sbeta thallasemia (Sbeta(+)or Sbeta(0)) (35.6% vs 25.5%; P =.03). Within genotype, mean Hb levels were significantly lower and reticulocyte counts were significantly higher in the patients with pica. Overall, the mean age of patients with pica was significantly lower; however, the prevalence was 23.3% (27/116) among those aged 10.0 to 14.9 years and 14.8% (8/54) among those aged 15.0 to 19.0 years. Within age groups, patients with pica weighed significantly less.
Conclusions:
Pica appeared to have an unusually high prevalence in patients with sickle cell disease and a correlation with lower Hb levels. It is unclear whether pica is a specific marker of disease severity, because our review did not show a relationship to increased number and duration of hospitalizations. The association between pica and low body weight suggests a nutritional effect on its prevalence.
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