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Adequacy of Dietary Intake Declines with Age in Children with Sickle Cell Disease

https://doi.org/10.1016/j.jada.2007.02.015Get rights and content

Abstract

Dietary intake (24-hour recall) was evaluated prospectively over four annual visits in 97 children and adolescents (53 female), aged 1.5 to 18.7 years, with sickle cell disease, type SS. Macro- and micronutrient intakes were compared to Dietary Reference Intakes (DRI) and expressed as %DRI. z scores for height, weight, and body mass index were calculated to assess growth status. Both t tests and Mann-Whitney U tests were used for year 1 comparisons, and longitudinal mixed effects analysis was used for the longitudinal data. Intake of vitamins E and D, folate, calcium, and fiber as %DRI was low for children of all ages. Intake of protein, vitamin C, riboflavin, vitamin B-12, and magnesium was lower by at least 28% DRI in the oldest (aged 14 to 18 years) compared to the youngest children (aged 1 to 3 years), and intake of vitamin A, magnesium, and phosphorus was suboptimal in children older than 9 years. After adjusting for initial age and sex, intake of riboflavin, zinc, calcium, magnesium, and phosphorus declined steeply (8% to 16% DRI annually) across the 3 years. Weight and body mass index z scores also declined over time. Dietary intake was particularly poor in adolescents. Efforts are needed to ensure dietary adequacy in children with sickle cell disease, type SS and to understand the etiology of poor dietary intake.

Section snippets

Methods

A sample of children with SCD-SS, aged 1 to 18 years from the Sickle Cell Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, were enrolled in a prospective cohort study, and four annual assessments (year 1, 2, 3, and 4) of dietary intake and growth were performed. All patients who met the inclusion criteria and came to the clinic were invited to participate in the study. SCD-SS genotype was determined by standard methods. Exclusion criteria for enrollment included other

Results and Discussion

This is the first report of longitudinal nutrient intake patterns in a large contemporary sample of US children and adolescents with SCD-SS. Ninety-seven children (53 female), aged 1.5 to 18.7 years (mean age 8.7±4.7 years) completed year 1 dietary and growth evaluations. During the following 3 years, five subjects started chronic transfusion therapy due to stroke or risk of stroke, and 13 subjects were prescribed hydroxyurea medication and were included in the analysis as planned. By the final

Conclusions

Energy intake of children with SCD-SS was suboptimal, particularly for children 4 years of age and older. Nutrients of most concern were vitamins D and E, folate, calcium, magnesium, zinc, and fiber. The decline in the quality of the diet with age and over time likely contributes to their poor growth status particularly striking by adolescence.

Further attention should be given to maintaining appropriate energy intake and micronutrient adequacy in persons with SCD-SS. The dropoff in

D. A. Kawchak is a sickle cell research coordinator, J. I. Schall is associate director, Nutrition and Growth Laboratory, B. S. Zemel is director, Nutrition and Growth Laboratory, and V. A. Stallings is director, Nutrition Research Center, The Children⁎s Hospital of Philadelphia, Division of Gastroenterology, Hepatology, and Nutrition, Philadelphia, PA.

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    D. A. Kawchak is a sickle cell research coordinator, J. I. Schall is associate director, Nutrition and Growth Laboratory, B. S. Zemel is director, Nutrition and Growth Laboratory, and V. A. Stallings is director, Nutrition Research Center, The Children⁎s Hospital of Philadelphia, Division of Gastroenterology, Hepatology, and Nutrition, Philadelphia, PA.

    K. Ohene-Frempong is director, Comprehensive Sickle Cell Center, The Children⁎s Hospital of Philadelphia, Hematology Division, Philadelphia, PA.

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