Underweight children older than 5 years with sickle cell anemia are at risk for early mortality in a low-resource...

Area of Science:

• Pediatrics
• Hematology
• Nutritional Science

Background:

• Undernutrition is a known risk factor for mortality in young children.
• Its role in mortality for older children and adults with sickle cell anemia (SCA) is less understood.
• Sickle cell anemia (SCA) affects children globally, with significant impact in regions like Nigeria.

Purpose of the Study:

• To test the hypothesis that underweight is associated with mortality in school-aged children (5-12 years) with SCA.
• To identify nutritional status as a potential risk factor for mortality in this vulnerable population.
• To evaluate the utility of underweight as a screening tool for mortality risk in children with SCA.

Main Methods:

• Secondary analysis of data from the Primary Prevention of Stroke in Children with Sickle Cell Disease in Nigeria trial.
• Classification of nutritional status using World Health Organization growth references: underweight (weight-for-age z score), stunting (height-for-age z score), and wasting (body mass index z score).
• Pooled analysis to assess the association between weight-for-age z score and mortality hazard.

Main Results:

• Children with SCA who died during the study had a lower mean weight-for-age z score compared to survivors.
• A lower weight-for-age z score was significantly associated with an increased hazard of death.
• Underweight participants (weight-for-age z score <-1) exhibited a higher probability of death during follow-up.

Conclusions:

• Underweight status is a previously unrecognized risk factor for early mortality in school-aged children with SCA in Nigeria.
• Nutritional assessment, specifically identifying underweight, can serve as a simple screening method for children with SCA at risk of death.
• Findings highlight the critical interplay between nutrition and mortality in pediatric SCA, emphasizing the need for nutritional interventions.