Comparative study of the growth and nutritional status of Brazilian and Nigerian school-aged children with sickle cell disease

Background: Comparative studies of patients in different sociogeographic/ecological zones may unravel potential environmental and nutritional factors influencing disease phenotype. In sickle cell disease (SCD), differential access to comprehensive care may influence their growth and nutritional status. Methods: From June 2015 to February 2016, steady-state nutritional parameters of 109 Brazilian and 95 Nigerian children with SCD attending routine clinic visits at Universidade Federal de Sao Paulo, Brazil and Obafemi Awolowo University Teaching Hospital, Ile-Ife (Ilesa unit), respectively, were compared. Results: A relatively high proportion of the children in both centres (23.5%) were wasted [body-mass index (BMI)-for-age z-score<-2). BMI-for-age z-score, height-for-age z-score, upper arm fat area and fat percentage were lower in the Nigerian cohorts. More Nigerians, 29.5% (28/95) against 18.3% (20/109) were wasted, and had short stature, [12.6% (12/95) vs. 3.7% (4/109)] than Brazilians. A higher proportion of Brazilian patients were overweight or obese (9.2 vs. 4.3%), and taller for age (15.6 vs. 8.4%). None of the Nigerian patients had severe vitamin D deficiency, only 12.6% (12/95) had suboptimal vitamin D and 1.1% (1/95) had low serum zinc levels, unlike 79.8% (87/109) of the Brazilian patients with suboptimal vitamin D and 10.1% (11/109) with low zinc. Conclusion: Undernutrition is still prevalent among the two cohorts. Nigerian patients were thinner and had reduced linear growth for age. This observation justifies the continued need for specialized nutritional care for children with SCD. In addition to hydroxyurea therapy, research is needed to determine appropriate nutritional intervention and exercise regimens for these children.CNPqUniv Fed Sao Paulo, Escola Paulista Med, Haematol & Blood Transfus Div, Sao Paulo, BrazilObafemi Awolowo Univ, Dept Pediat & Child Hlth, Ife, NigeriaKuwait Univ, Fac Med, Dept Paediat, Kuwait, KuwaitUniv Fed Sao Paulo, Escola Paulista Med, Dept Pediat, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Haematol & Blood Transfus Div, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Pediat, Sao Paulo, BrazilCNPq: 159581/2014-1Web of Scienc