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Risk factors in underweight older children with sickle cell anemia: a comparison of low- to high-income countries

Lauren Jane Klein1,2, Shehu Umar Abdullahi3, Safiya Gambo4

  • 1D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.

Blood Advances
|September 27, 2023
PubMed

Insights

Older children with sickle cell anemia (SCA) are at higher risk of being underweight. This study found that older age and lower hemoglobin levels are key risk factors for underweight status in children with SCA across different income settings.

Area of Science:

  • Pediatrics
  • Hematology
  • Global Health

Background:

  • Previous research indicated a higher mortality risk for underweight children with sickle cell anemia (SCA) in Nigeria.
  • Underweight status is a significant concern for children with SCA, particularly in resource-limited settings.

Purpose of the Study:

  • To identify risk factors associated with being underweight in children aged 5 to 12 years with SCA.
  • To compare the prevalence of underweight status in low-income (Nigeria) and high-income (North America/Europe) settings.

Main Methods:

  • A cross-sectional study utilizing data from the Primary Prevention of Stroke in Children with Sickle Cell Disease in Nigeria (SPRING) and Silent Cerebral Infarct (SIT) trials.
  • Analysis included 928 participants from the SPRING trial (low-income) and 1093 from the SIT trial (high-income).
  • Weight-for-age z scores were used to define underweight (<-1) and severely underweight (<-3) status.

Main Results:

  • A significantly higher proportion of underweight children were identified in the low-income SPRING cohort (87.9%) compared to the high-income SIT cohort (25.7%).
  • Severely underweight children were also more prevalent in the SPRING cohort (22.7%) versus the SIT cohort (0.7%).
  • In the combined cohort, older age (OR, 1.24) and lower hemoglobin levels (OR, 0.67) were significantly associated with being underweight.

Conclusions:

  • Older age and lower hemoglobin levels are significant risk factors for underweight status in children with SCA, irrespective of income setting.
  • These findings highlight the need for targeted nutritional and clinical monitoring for children with SCA, especially in resource-limited regions.
  • Further research may explore interventions to mitigate underweight status and improve health outcomes in this population.

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