Lipid profile and nutritional status of a pediatric population with sickle cell anemia: differences between gender and association with severity markers
DOI:
https://doi.org/10.33448/rsd-v10i10.18934Keywords:
Sickle cell anemia; Dyslipidemia; Apolipoprotein A1; Nutrition status; Vitamin A; Vitamin D.Abstract
Objective: To investigate the associations between nutritional status and lipid profile with biomarkers of hemolysis and inflammation in sickle cell anemia, in addition to considering gender differences. Methods: This cross-sectional study analyzed nutritional, and biochemical data of pediatric patients carrying sickle cell anemia. Results: Vitamin A, apolipoprotein B, total cholesterol, low-density lipoprotein, and non-high-density lipoprotein cholesterol were lower in boys. Hemoglobin was significantly lower, and the white blood cells and lactate dehydrogenase were higher in boys. Body mass index, vitamin A, and triglycerides were associated with hemoglobin levels, while apolipoprotein A-I was associated with white blood cells and total bilirubin. Additionally, body mass index and vitamin A were associated with lactate dehydrogenase. Vitamin A showed significant predictive power in hemoglobin alteration and lactate dehydrogenase, while apolipoprotein A-I was able to predict high white blood cells values and total bilirubin. Conclusion: This study found in a pediatric population with sickle cell anemia that body mass index, vitamin A, triglycerides, and apolipoprotein A-I were associated with biomarkers of hemolysis and inflammation. Boys exhibited the greater nutritional deficit and severity of the disease.
References
Adegoke, S. A., Braga, J. A. P., Adekile, A. D., & Figueiredo, M. S. (2017). Impact of Hydroxyurea on anthropometry and serum 25-hydroxyvitamin D among children with sickle cell disease. Journal of Pediatric Hematology/Oncology, 40(4), 243–247.
Adegoke, S. A., Figueiredo, M. S., Adekile, A. D., & Braga, A. P. (2017). Comparative study of the growth and nutritional status of Brazilian and Nigerian school-aged children with sickle cell disease. Int Health, 9, 327–334. https://doi.org/10.1093/inthealth/ihx035
Adegoke, S. A., Okeniyi, J. A. O., & Akintunde, A. A. (2016). Electrocardiographic abnormalities and dyslipidaemic syndrome in children with sickle cell anaemia. Cardiovascular Journal of Africa, 27(1), 16–20. https://doi.org/10.5830/CVJA-2015-059
Akinlade, K. S., Adewale, C. O., Rahamon, S. K., Fasola, F. A., Olaniyi, J. A., & Atere, A. D. (2014). Defective lipid metabolism in sickle cell anaemia subjects in vaso-occlusive crisis. Nigerian Medical Journal, 55(5), 428–431. https://doi.org/10.4103/0300-1652.140388
Aleluia, M. M., Guarda, C. C., Santiago, R. P., Fonseca, T. C. C., Neves, F. I., Souza, R. Q., Larissa Alves Farias, L. A., Pimenta, F. A., Fiuza, L. M., Pitanga, T. N., Ferreira, J. R. D. Adorno, E. V., Cerqueira, B. A. V., Gonçalves, M. de S. (2017). Association of classical markers and establishment of the dyslipidemic sub-phenotype of sickle cell anemia. Lipids in Health and Disease, 16(74), 1–9. https://doi.org/10.1186/s12944-017-0454-1
Alyahya, K. O. (2017). Vitamin D levels in schoolchildren: A cross-sectional study in Kuwait. BMC Pediatrics, 17(1), 1–10. https://doi.org/10.1186/s12887-017-0963-0
Barbalho, S. M., Oshiiwa, M., Sato Fontana, L. C., Ribeiro Finalli, E. F., Paiva Filho, M. E., & Machado Spada, A. P. (2017). Metabolic syndrome and atherogenic indices in school children: A worrying panorama in Brazil. Diabetes and Metabolic Syndrome: Clinical Research and Reviews, 11(2016), S397–S401. https://doi.org/10.1016/j.dsx.2017.03.024
Baydas, G., Karatas, F., Gursu, M. F., Bozkurt, H. A., Ilhan, N., Yasar, A., & Canatan, H. (2002). Antioxidant vitamin levels in term and preterm infants and their relation to maternal vitamin status. Archives of Medical Research, 33(3), 276–280. https://doi.org/10.1016/S0188-4409(02)00356-9
Behera, S., Dixit, S., Bulliyya, G., & Kar, S. K. (2012). Vitamin a status and hematological values in sickle cell disorder cases. Indian Journal of Medical Sciences, 66(7), 169. https://doi.org/10.4103/0019-5359.114180
Biswal, S., Rizwan, H., Pal, S., Sabnam, S., Parida, P., & Pal, A. (2018). Oxidative stress, antioxidant capacity, biomolecule damage, and inflammation symptoms of sickle cell disease in children. Hematology, 24(1), 1–9. https://doi.org/10.1080/10245332.2018.1498441
Blaner, W. S., O’Byrne, S. M., Wongsiriroj, N., Kluwe, J., D’Ambrosio, D. M., Jiang, H., Schwabe, R. F., Hillman, E. M. C., Piantedosi, R., Libien, J. (2009). Hepatic stellate cell lipid droplets: A specialized lipid droplet for retinoid storage. Biochimica et Biophysica Acta, 1791(6), 467–473. https://doi.org/10.1016/j.bbalip.2008.11.001
Brownell, J. N., Schall, J. I., Mcanlis, C. R., Smith-Whitley, K., Norris, C. F., & Stallings, V. A. (2020). Effect of high-dose vitamin A supplementation in children with sickle cell disease. Journal of Pediatric Hematology/Oncology, 42(2), 83–91. https://doi.org/10.1097/MPH.0000000000001673
Cohen, J. (1988) Statistical Power Analysis for the Behavioral Sciences (2nd ed.) New York: Lawrence Erlbaum Associates.
Dougherty, K. A, Schall, J. I., Kawchak, D. A, Green, M. H., Ohene-frempong, K., Zemel, B. S., & Stallings, V. A. (2012). No improvement in suboptimal vitamin A status with a randomized , double-blind , placebo-controlled trial of vitamin A supplementation in children with sickle cell disease. The American Journal Clinical Nutrition, 96, 932–940. https://doi.org/10.3945/ajcn.112.035725
Ephraim, R. K. D., Adu, P., Ake, E., Agbodzakey, H., Adoba, P., Cudjoe, O., & Agoni, C. (2016). Normal Non-HDL Cholesterol, Low Total Cholesterol, and HDL Cholesterol Levels in Sickle Cell Disease Patients in the Steady State: A Case-Control Study of Tema Metropolis. Journal of Lipids, 2016, 1–5. https://doi.org/10.1155/2016/7650530
Esezobor, C. I., Akintan, P., Akinsulie, A., Temiye, E., & Adeyemo, T. (2016). Wasting and stunting are still prevalent in children with sickle cell anaemia in Lagos , Nigeria. Italian Journal of Pediatrics, 42, 1–8. https://doi.org/10.1186/s13052-016-0257-4
Filgueiras, M. D. S., Suhett, L. G., Silva, M. A., Rocha, N. P., & Novaes, J. F. De. (2018). Lower vitamin D intake is associated with low HDL cholesterol and vitamin D insufficiency / deficiency in Brazilian children. 25, 1–9. https://doi.org/10.1017/S1368980018000204
García-Morin, M., López-Sangüos, C., Vázquez, P., Alvárez, T., Marañón, R., Huerta, J., & Cela, E. (2016). Lactate Dehydrogenase: A Marker of the Severity of Vaso-Occlusive Crisis in Children with Sickle Cell Disease Presenting at the Emergency Department. Hemoglobin, 40(6), 388–391. https://doi.org/10.1080/03630269.2016.1275677
Hassan, M. (2017). ANGPLT3: A novel modulator of lipid metabolism. Global Cardiology Science and Practice, 2017(1), 1–7. https://doi.org/10.21542/gcsp.2017.6
Hochman, B., Nahas, F. X., Oliveira Filho, R. S., Ferreira, L. M. (2005). Desenhos de pesquisa. Acta Cirúrgica Brasileira, 20(Suppl. 2), 2-9. https://doi.org/10.1590/S0102-86502005000800002
Institute National Heart Lung and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. (pp. 4–83). (2012). https://doi.org/10.1542/peds.2009-2107C
Jackson, T. C., Krauss, M. J., Debaun, M. R., Strunk, R. C., & Arbeláez, A. M. (2012). Vitamin D deficiency and comorbidities in children with sickle cell anemia. Pediatric Hematology and Oncology, 29(3), 261–266. https://doi.org/10.3109/08880018.2012.661034
Jesus, A. C. S., Konstantyner, T., Lôbo, I. K. V., & Braga, J. A. P. (2018). Socioeconomic and nutritional characteristics of children and adolescents with sickle cell anemia: A systematic review. Revista Paulista de Pediatria, 36(4), 491–499. https://doi.org/10.1590/1984-0462/;2018;36;4;00010
Kazadi, A. L., Ngiyulu, R. M., Gini-Ehungu, J. L., Mbuyi-Muamba, J. M., & Aloni, M. N. (2017). Factors associated with growth retardation in children suffering from sickle cell anemia: First report from central Africa. Anemia, 2017. https://doi.org/https://doi.org/10.1155/2017/7916348
Kersten, S. (2017). Angiopoietin-like 3 in lipoprotein metabolism. Nature Reviews Endocrinology, 13(12), 731–739. https://doi.org/10.1038/nrendo.2017.119
Lalanne-Mistrih, M.-L., Connes, P., Lamarre, Y., Lemonne, N., Hardy-Dessources, M.-D., Tarer, V., Etienne-Julan, M., Mougenel, D., Tressières, B., & Romana, M. (2018). Lipid profiles in French West Indies sickle cell disease cohorts, and their general population. Lipids in Health and Disease, 17(1), 38. https://doi.org/10.1186/s12944-018-0689-5
Lee, M. T., Licursi, M., & McMahon, D. J. (2015). Vitamin D deficiency and acute vaso-occlusive complications in children with sickle cell disease. Pediatric Blood Cancer, 62, 643–647. https://doi.org/10.1002/pbc.25399
Li, Y., & Teng, C. (2014). Angiopoietin-like proteins 3, 4 and 8: Regulating lipid metabolism and providing new hope for metabolic syndrome. Journal of Drug Targeting, 22(8), 679–687. https://doi.org/10.3109/1061186X.2014.928715
Martyres, D. J., Vijenthira, A., Barrowman, N., Harris-Janz, S., Chretien, C., & Klaassen, R. J. (2016). Nutrient insufficiencies/deficiencies in children with sickle cell disease and its association with increased disease severity. Pediatric Blood Cancer, 63(6), 1060–1064. https://doi.org/10.1002/pbc.25940
Mikobi, T. M., Tshilobo, P. L., Aloni, M. N., Akilimali, P. Z., Mvumbi-Lelo, G., & Mbuyi-Muamba, J. M. (2017). Clinical phenotypes and the biological parameters of Congolese patients suffering from sickle cell anemia : A first report from Central Africa. J Clin Lab Anal, 31(6), 1–6. https://doi.org/10.1002/jcla.22140
Mokondjimobe, É., Longo-Mbenza, B., Ovono-Abessolo, F., Gombet, T., Guie, G., Ngou-Milama, E., & Parra, H. J. (2012). Évaluation du profil lipoprotéique et du risque athérogène chez les drépanocytaires homozygotes et hétérozygotes de Brazzaville. Annales de Biologie Clinique, 70(2), 183–188. https://doi.org/10.1684/abc.2012.0687
Navab, M., Reddy, S. T., Van Lenten, B. J., & Fogelman, A. M. (2011). HDL and cardiovascular disease: Atherogenic and atheroprotective mechanisms. Nature Reviews Cardiology, 8(4), 222–232. https://doi.org/10.1038/nrcardio.2010.222
Odetunde, O. I., Chinawa, J. M., Achigbu, K. I., & Achigbu, E.O. (2016). Body Mass Index and other anthropometric variables in children with sickle cell anaemia. Pakistan Journal of Medical Sciences, 32(2), 341–346.
Oztas, Y., Unal, S., Eskandari, G., Tamer, L., & Ozgunes, N. (2018). Vitamin D deficiency and its association with inflammatory markers, lipid profile and regulatory t-cells in pediatric sickle cell disease patients. Indian Journal of Hematology and Blood Transfusion, 34(3), 480–485. https://doi.org/10.1007/s12288-017-0890-0
Praharaj, D. L., & Anand, A. C. (2021). Sickle Hepatopathy. Journal of Clinical and Experimental Hepatology, 11(1), 82–96. https://doi.org/10.1016/j.jceh.2020.08.003
Rees, D. C., Williams, T. N., & Gladwin, M. T. (2010). Sickle-cell disease. The Lancet, 376(9757), 2018–2031. https://doi.org/10.1016/S0140-6736(10)61029-X
Portney, L.G., &Watkins, M.P. (2007). Foundations of Clinical Research: Applications to Practice. Pearson (3rd ed.). Upper Saddle River, N.J: Pearson/Prentice Hall.
Sabarense, A. P., Lima, G. O., Silva, L. M. L., & Viana, M. B. (2015). Characterization of mortality in children with sickle cell disease diagnosed through the Newborn Screening Program. Jornal de Pediatria (Versão Em Português), 91(3), 242–247. https://doi.org/10.1016/j.jpedp.2015.03.009
Schall, J. I., Zemel, B. S., Kawchak, D. A., Ohene-Frempong, K., & Stallings, V. A. (2004). Vitamin A status, hospitalizations, and other outcomes in young children with sickle cell disease. Journal of Pediatrics, 145(1), 99–106. https://doi.org/10.1016/j.jpeds.2004.03.051
Steinberg, M. H. (2008). Sickle cell anemia, the first molecular disease: Overview of molecular etiology, pathophysiology, and therapeutic approaches. The Scientific World Journal, 8, 1295–1324. https://doi.org/10.1100/tsw.2008.157
Teixeira, R. S., Arriaga, M. B., Terse-Ramos, R., Ferreira, T. A., Machado, V. R., Rissatto-Lago, M. R., Silveira, P. S., Boa-Sorte, N., Ladeia, A. M. T., & Andrade, B. B. (2019). Higher values of triglycerides:HDL-cholesterol ratio hallmark disease severity in children and adolescents with sickle cell anemia. Brazilian Journal of Medical and Biological Research, 52(10), e8833. https://doi.org/10.1590/1414-431X20198833
Teixeira, R. S., Terse-Ramos, R., Ferreira, T. A., Machado, V. R., Perdiz, M. I., Lyra, I. M., Nascimento, V. L., Boa-Sorte, N., Andrade, B B., & Ladeia, A. M. (2017). Associations between endothelial dysfunction and clinical and laboratory parameters in children and adolescents with sickle cell anemia. Plos One, 12(9), 1–14. https://doi.org/10.1371/journal.pone.0184076
Valente-Frossard, T. N. S., Cruz, N. R. C., Ferreira, F. O., Belisário, A. R., Pereira, B. M., Gomides, A. F. F., Resende, G. A. D., Carlos, A. M., Moraes-Souza, H., & Velloso-Rodrigues, C. (2020). Polymorphisms in genes that affect the variation of lipid levels in a Brazilian pediatric population with sickle cell disease : rs662799 APOA5 and rs964184 ZPR1. Blood Cells, Molecules and Diseases, 80(102376). https://doi.org/10.1016/j.bcmd.2019.102376
Vendrame, F., Olops, L., Saad, S. T. O., Costa, F. F., & Fertrin, K. Y. (2019). Hypocholesterolemia and dysregulated production of angiopoietin-like proteins in sickle cell anemia patients. Cytokine, 120, 88–91. https://doi.org/10.1016/j.cyto.2019.04.014
Vona, R., Sposi, N. M., Mattia, L., Gambardella, L., Straface, E., & Pietraforte, D. (2021). Sickle cell disease: Role of oxidative stress and antioxidant therapy. Antioxidants, 10(2), 1–27. https://doi.org/10.3390/antiox10020296
Wastnedge, E., Waters, D., Patel, S., Morrison, K., Goh, M. Y., Adeloye, D., & Rudan, I. (2018). The global burden of sickle cell disease in children under five years of age: A systematic review and meta-analysis. Journal of Global Health, 8(2), 1–9. https://doi.org/10.7189/jogh.08.021103
World Health Organization. (2009). Software for assessing growth of the worlds children and adolescents. In Who Antro Plus for Personal Computers Manual.
Zhang, R. (2016). The ANGPTL3-4-8 model, a molecular mechanism for triglyceride trafficking. Open Biology, 6(4), 1–11. https://doi.org/10.1098/rsob.150272
Zorca, S., Freeman, L., Hildesheim, M., Allen, D., Remaley, A. T., Taylor, J. G., & Kato, G. J. (2010). Lipid levels in sickle-cell disease associated with haemolytic severity, vascular dysfunction and pulmonary hypertension. British Journal of Haematology, 149(3), 436–445. https://doi.org/10.1111/j.1365-2141.2010.08109.x
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Nilcemar Rodrigues Carvalho Cruz; Thaisa Netto Souza Valente ; Fernanda Oliveira Ferreira; Leandro Roberto de Macedo; Andreza da Silva Brito Rocha; Dayenne Paula Nascimento; Antônio Frederico de Freitas Gomides; Maria Anete Santana Valente; Jacqueline Isaura Alvarez-Leite; Cibele Velloso-Rodrigues
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
