EVALUATION OF THE FOOD INTAKE, NUTRITIONAL STATUS AND NUTRITIONAL DEFICIENCY IN CHILDREN WITH SICKLE CELL DISEASE: PRELIMINARY RESULTS OF A CROSS - SECTIONAL STUDY
(Abstract release date: 05/19/16)
EHA Library. Menzato F. 06/09/16; 133025; E1476
Ms. Federica Menzato
Contributions
Contributions
Abstract
Abstract: E1476
Type: Eposter Presentation
Background
Children with Sickle Cell Disease (SCD) have poor growth compared to their peers; they also present a higher percentage of cognitive impairment compared to age matched controls. Clinical practice shows that the presence of nutritional deficiencies with important clinical implications (anemia, abnormal bone metabolism...) is frequent in these patients and that it can have an adverse impact on disease severity. Currently there are no European studies that correlate specific nutritional deficiency to the nutritional intake; demonstrating the correlation between reduced or inappropriate dietary intake and selective nutritional deficiencies could lead to targeted nutritional interventions aimed at improving the nutritional status and the altered hematological parameters.
Aims
1) To identify any nutritional deficiencies in patients with SCD and correct them promptly . 2) To identify, if possible, the correlations between nutritional status, dietary intakes and deficiency states, and between states of deficiency and clinical expression of the disease, including patient's performance assessed through ad hoc questionnaires.
Methods
Children with SCD of the clinic of Pediatric Hematology-Oncology in Padua were included in this prospective study. An ad hoc questionnaire (on food frequency, quantity and eating habits) was administered; the data were processed with GEDIP 4 software to derive the minimum, average amounts, maximum and standard deviations of various nutrients and to compare them with the recommended requirements in the Recommended intake levels (RDAs, 2014 edition).Nutritional status was assessed by weight, height, Body Mass Index and arm circumference that were used for drawing the percentiles using CDC growth curves.The following hematochemical parameters were evaluated at Time 0: Complete Blood Count, PTH, Vitamins A, D, E, ferritin, serum iron, zinc, copper, calcium, phosphate, folic acid, methylmalonic acid, homocysteine , blood gas analysis. These parameters will be re-assessed at Time 1 (6 months) and 2 (12 months) to evaluate the effectiveness of any additional therapy.
Results
72 consecutive pediatric patients with SCD were included in our study (SS 62/72, 8/72 SC, 2/72 Sß), 31 F and 41 M, mean age 9.6 years (range: 8 months-23 years), from 1st March 2015 to 31st August 2015.The main nutritional deficiencies were: folic acid (9/72); Vitamin D (62/72) correlated with increased PTH (27/72); Vitamin A (43/72); Vitamin E (0/72); serum iron (23/72); zinc (18/72).In some cases high levels of methylmalonic acid (10/72) and homocysteine (4/71) have been reported, showing lack of Vitamin B12.The following supplementations were given: folic acid (55/72), vitamin D (57/72), iron (15/72), zinc (1/72); in the remaining cases with slight deficits were provided appropriate dietary advices.At the moment 37/72 patients underwent the nutritional assessment questionnaire, which shows a nutritional intake of 69% of energy intake established by the RDAs, and values between 25° and 50°P for weight, height, BMI and arm circumference for age. Their protein intake is on average 150% from the RDAs, while recording contributions of about 50% for calcium, iron and folic acid and 8% for Vitamin D.Even if most of the patients are African first generation immigrants with a specific but balanced dietary habits; a significant part of them belongs to low-income families and feeds with “junk food”, which could be the cause of their nutritional deficits.
Conclusion
Preliminary data of our study does not show an adequate intake of macro and micro nutrients for SCD children; calcium, iron, folic acid and especially Vitamin D are the most deficient nutrients and determine suboptimal growth state. The continuation of the study, with a larger number of subjects, will help us to highlight the possible correlation of nutritional status with the progress and severity of the disease.
Session topic: E-poster
Keyword(s): Pediatric, Sickle cell disease
Type: Eposter Presentation
Background
Children with Sickle Cell Disease (SCD) have poor growth compared to their peers; they also present a higher percentage of cognitive impairment compared to age matched controls. Clinical practice shows that the presence of nutritional deficiencies with important clinical implications (anemia, abnormal bone metabolism...) is frequent in these patients and that it can have an adverse impact on disease severity. Currently there are no European studies that correlate specific nutritional deficiency to the nutritional intake; demonstrating the correlation between reduced or inappropriate dietary intake and selective nutritional deficiencies could lead to targeted nutritional interventions aimed at improving the nutritional status and the altered hematological parameters.
Aims
1) To identify any nutritional deficiencies in patients with SCD and correct them promptly . 2) To identify, if possible, the correlations between nutritional status, dietary intakes and deficiency states, and between states of deficiency and clinical expression of the disease, including patient's performance assessed through ad hoc questionnaires.
Methods
Children with SCD of the clinic of Pediatric Hematology-Oncology in Padua were included in this prospective study. An ad hoc questionnaire (on food frequency, quantity and eating habits) was administered; the data were processed with GEDIP 4 software to derive the minimum, average amounts, maximum and standard deviations of various nutrients and to compare them with the recommended requirements in the Recommended intake levels (RDAs, 2014 edition).Nutritional status was assessed by weight, height, Body Mass Index and arm circumference that were used for drawing the percentiles using CDC growth curves.The following hematochemical parameters were evaluated at Time 0: Complete Blood Count, PTH, Vitamins A, D, E, ferritin, serum iron, zinc, copper, calcium, phosphate, folic acid, methylmalonic acid, homocysteine , blood gas analysis. These parameters will be re-assessed at Time 1 (6 months) and 2 (12 months) to evaluate the effectiveness of any additional therapy.
Results
72 consecutive pediatric patients with SCD were included in our study (SS 62/72, 8/72 SC, 2/72 Sß), 31 F and 41 M, mean age 9.6 years (range: 8 months-23 years), from 1st March 2015 to 31st August 2015.The main nutritional deficiencies were: folic acid (9/72); Vitamin D (62/72) correlated with increased PTH (27/72); Vitamin A (43/72); Vitamin E (0/72); serum iron (23/72); zinc (18/72).In some cases high levels of methylmalonic acid (10/72) and homocysteine (4/71) have been reported, showing lack of Vitamin B12.The following supplementations were given: folic acid (55/72), vitamin D (57/72), iron (15/72), zinc (1/72); in the remaining cases with slight deficits were provided appropriate dietary advices.At the moment 37/72 patients underwent the nutritional assessment questionnaire, which shows a nutritional intake of 69% of energy intake established by the RDAs, and values between 25° and 50°P for weight, height, BMI and arm circumference for age. Their protein intake is on average 150% from the RDAs, while recording contributions of about 50% for calcium, iron and folic acid and 8% for Vitamin D.Even if most of the patients are African first generation immigrants with a specific but balanced dietary habits; a significant part of them belongs to low-income families and feeds with “junk food”, which could be the cause of their nutritional deficits.
Conclusion
Preliminary data of our study does not show an adequate intake of macro and micro nutrients for SCD children; calcium, iron, folic acid and especially Vitamin D are the most deficient nutrients and determine suboptimal growth state. The continuation of the study, with a larger number of subjects, will help us to highlight the possible correlation of nutritional status with the progress and severity of the disease.
Session topic: E-poster
Keyword(s): Pediatric, Sickle cell disease
Abstract: E1476
Type: Eposter Presentation
Background
Children with Sickle Cell Disease (SCD) have poor growth compared to their peers; they also present a higher percentage of cognitive impairment compared to age matched controls. Clinical practice shows that the presence of nutritional deficiencies with important clinical implications (anemia, abnormal bone metabolism...) is frequent in these patients and that it can have an adverse impact on disease severity. Currently there are no European studies that correlate specific nutritional deficiency to the nutritional intake; demonstrating the correlation between reduced or inappropriate dietary intake and selective nutritional deficiencies could lead to targeted nutritional interventions aimed at improving the nutritional status and the altered hematological parameters.
Aims
1) To identify any nutritional deficiencies in patients with SCD and correct them promptly . 2) To identify, if possible, the correlations between nutritional status, dietary intakes and deficiency states, and between states of deficiency and clinical expression of the disease, including patient's performance assessed through ad hoc questionnaires.
Methods
Children with SCD of the clinic of Pediatric Hematology-Oncology in Padua were included in this prospective study. An ad hoc questionnaire (on food frequency, quantity and eating habits) was administered; the data were processed with GEDIP 4 software to derive the minimum, average amounts, maximum and standard deviations of various nutrients and to compare them with the recommended requirements in the Recommended intake levels (RDAs, 2014 edition).Nutritional status was assessed by weight, height, Body Mass Index and arm circumference that were used for drawing the percentiles using CDC growth curves.The following hematochemical parameters were evaluated at Time 0: Complete Blood Count, PTH, Vitamins A, D, E, ferritin, serum iron, zinc, copper, calcium, phosphate, folic acid, methylmalonic acid, homocysteine , blood gas analysis. These parameters will be re-assessed at Time 1 (6 months) and 2 (12 months) to evaluate the effectiveness of any additional therapy.
Results
72 consecutive pediatric patients with SCD were included in our study (SS 62/72, 8/72 SC, 2/72 Sß), 31 F and 41 M, mean age 9.6 years (range: 8 months-23 years), from 1st March 2015 to 31st August 2015.The main nutritional deficiencies were: folic acid (9/72); Vitamin D (62/72) correlated with increased PTH (27/72); Vitamin A (43/72); Vitamin E (0/72); serum iron (23/72); zinc (18/72).In some cases high levels of methylmalonic acid (10/72) and homocysteine (4/71) have been reported, showing lack of Vitamin B12.The following supplementations were given: folic acid (55/72), vitamin D (57/72), iron (15/72), zinc (1/72); in the remaining cases with slight deficits were provided appropriate dietary advices.At the moment 37/72 patients underwent the nutritional assessment questionnaire, which shows a nutritional intake of 69% of energy intake established by the RDAs, and values between 25° and 50°P for weight, height, BMI and arm circumference for age. Their protein intake is on average 150% from the RDAs, while recording contributions of about 50% for calcium, iron and folic acid and 8% for Vitamin D.Even if most of the patients are African first generation immigrants with a specific but balanced dietary habits; a significant part of them belongs to low-income families and feeds with “junk food”, which could be the cause of their nutritional deficits.
Conclusion
Preliminary data of our study does not show an adequate intake of macro and micro nutrients for SCD children; calcium, iron, folic acid and especially Vitamin D are the most deficient nutrients and determine suboptimal growth state. The continuation of the study, with a larger number of subjects, will help us to highlight the possible correlation of nutritional status with the progress and severity of the disease.
Session topic: E-poster
Keyword(s): Pediatric, Sickle cell disease
Type: Eposter Presentation
Background
Children with Sickle Cell Disease (SCD) have poor growth compared to their peers; they also present a higher percentage of cognitive impairment compared to age matched controls. Clinical practice shows that the presence of nutritional deficiencies with important clinical implications (anemia, abnormal bone metabolism...) is frequent in these patients and that it can have an adverse impact on disease severity. Currently there are no European studies that correlate specific nutritional deficiency to the nutritional intake; demonstrating the correlation between reduced or inappropriate dietary intake and selective nutritional deficiencies could lead to targeted nutritional interventions aimed at improving the nutritional status and the altered hematological parameters.
Aims
1) To identify any nutritional deficiencies in patients with SCD and correct them promptly . 2) To identify, if possible, the correlations between nutritional status, dietary intakes and deficiency states, and between states of deficiency and clinical expression of the disease, including patient's performance assessed through ad hoc questionnaires.
Methods
Children with SCD of the clinic of Pediatric Hematology-Oncology in Padua were included in this prospective study. An ad hoc questionnaire (on food frequency, quantity and eating habits) was administered; the data were processed with GEDIP 4 software to derive the minimum, average amounts, maximum and standard deviations of various nutrients and to compare them with the recommended requirements in the Recommended intake levels (RDAs, 2014 edition).Nutritional status was assessed by weight, height, Body Mass Index and arm circumference that were used for drawing the percentiles using CDC growth curves.The following hematochemical parameters were evaluated at Time 0: Complete Blood Count, PTH, Vitamins A, D, E, ferritin, serum iron, zinc, copper, calcium, phosphate, folic acid, methylmalonic acid, homocysteine , blood gas analysis. These parameters will be re-assessed at Time 1 (6 months) and 2 (12 months) to evaluate the effectiveness of any additional therapy.
Results
72 consecutive pediatric patients with SCD were included in our study (SS 62/72, 8/72 SC, 2/72 Sß), 31 F and 41 M, mean age 9.6 years (range: 8 months-23 years), from 1st March 2015 to 31st August 2015.The main nutritional deficiencies were: folic acid (9/72); Vitamin D (62/72) correlated with increased PTH (27/72); Vitamin A (43/72); Vitamin E (0/72); serum iron (23/72); zinc (18/72).In some cases high levels of methylmalonic acid (10/72) and homocysteine (4/71) have been reported, showing lack of Vitamin B12.The following supplementations were given: folic acid (55/72), vitamin D (57/72), iron (15/72), zinc (1/72); in the remaining cases with slight deficits were provided appropriate dietary advices.At the moment 37/72 patients underwent the nutritional assessment questionnaire, which shows a nutritional intake of 69% of energy intake established by the RDAs, and values between 25° and 50°P for weight, height, BMI and arm circumference for age. Their protein intake is on average 150% from the RDAs, while recording contributions of about 50% for calcium, iron and folic acid and 8% for Vitamin D.Even if most of the patients are African first generation immigrants with a specific but balanced dietary habits; a significant part of them belongs to low-income families and feeds with “junk food”, which could be the cause of their nutritional deficits.
Conclusion
Preliminary data of our study does not show an adequate intake of macro and micro nutrients for SCD children; calcium, iron, folic acid and especially Vitamin D are the most deficient nutrients and determine suboptimal growth state. The continuation of the study, with a larger number of subjects, will help us to highlight the possible correlation of nutritional status with the progress and severity of the disease.
Session topic: E-poster
Keyword(s): Pediatric, Sickle cell disease
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