Ema Thake Graduate Seminar 2011 NUTR 6400 Can zinc
supplementation address growth restriction in children with Sickle
Cell Anemia?
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What is Sickle Cell Anemia? A hereditary disease in which red
blood cells are abnormally shaped like a crescent instead of in the
shape of a full disc.
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Causes Sickle cell anemia is caused by hemoglobin S, an
abnormal form of hemoglobin
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Diagnosis Patients are usually diagnosed around 4 months of
age. Tests for diagnosis can include: CBC Hemoglobin
electrophoresis Serum hgb, serum WBC Bilirubin, Serum creatinine
Sickle Cell Test Looks for sickle shaped blood cells (abnormal
hemoglobin)
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Symptoms Symptoms can include: Attacks of abdominal pain Bone
pain Breathlessness Jaundice Other symptoms: chest pain,
polydypsia, polyuria, stroke, skin ulcers, poor eyesight, blindness
Delayed growth and puberty
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Treatment There is no cure for sickle cell anemia In the past,
sickle cell patients often died between ages 20-40 due to organ
failure. Patients are in need of ongoing treatment Folic acid
supplements Antibiotics Pain medication Plenty of fluids Treatment
for any complications from SCD
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Growth restriction in children with sickle cell anemia
Henderson et al. 63 patients with sickle cell anemia were assessed
for growth 25% of subjects were less than the 5 th percentile of
National Center for Health Statistics growth standards for either
height/age, weight/age, or weight/height.
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Zinc Important in many biological functions: Energy metabolism,
protein synthesis, collagen formation, alcohol detoxification,
carbon dioxide elimination, sexual maturation, taste and smell
functions.
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Zinc Deficiency Symptoms: Poor wound healing, subnormal growth,
anorexia, changes in hair, skin, and nails Low plasma zinc levels
are associated with poor growth status versus normal plasma zinc
levels. Previous studies have linked zinc deficiency to growth
abnormalities in children with SCD. (Zemel et al.)
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Problem Most treatments of sickle cell anemia are focused on
pain management. Providing dietary intervention by supplementation
zinc may address growth problems in this population
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Purpose Examine the effects of zinc supplementation and growth
in children with sickle cell anemia.
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Babette S Zemel, Deborah A Kawchak, Ellen B Fung, Kwaku
Ohene-Frempong, and Virginia A Stallings Am J Clin Nutr
2002;75:300-7 Effect of zinc supplementation on growth and body
composition in children with sickle cell disease
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Study Design 12 month, randomized, placebo-controlled study of
zinc supplementation in children aged 4-10 years old with sickle
cell anemia. 42 children (20 girls, 22 boys) with SCD, ages 4-10
years old, were randomly assigned to receive 10mg supplemental zinc
or placebo. After randomization, subjects received either 10mg
elemental Zn in 5 ml of cherry syrup or 5 ml cherry syrup alone per
day.
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Methods Complete anthropometric assessments were completed at
baseline, 3, 6, and 12 months. Body composition was assessed using
DXA at baseline, 6, and 12 months. Dietary intake was assessed by
conducting 24-hour recall interviews at baseline, 3, 6, and 12
months. Fasting blood samples were collected at baseline, 3, 6, and
12 months to assess plasma zinc concentration. 6 subjects (15% of
sample size) had low serum zinc concentrations
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Results
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Discussion Children born with SCD seem normal at birth, but
develop significant growth deficits by age 5 (Kramer et al.).
Researchers determined that plasma zinc may not be a sensitive
indicator of limiting deficiency, especially in children with SCD,
where sickled hemoglobin may contaminate blood samples. In present
study, there were no significant differences in growth related to
baseline plasma zinc concentrations. However, zinc supplementation
was associated with linear growth and improved nutritional status.
It is debated whether this study used appropriate supplement doses
to see effects.
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Strengths/Limitations Study design Body composition assessed by
DXA scan Serum zinc levels were tested Small subject number Serum
zinc results were not reported throughout the 12 months No dietary
control
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Conclusions Results were insignificant in the present study,
however it was determined that children with sickle cell disease
may have zinc deficiency and could possibly benefit from zinc
supplementation to improve growth and weight gain.
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References Zemel BS, Kawchak DA, Fung EB, Ohene-Frempong K,
Stallings VA. Effect of zinc supplementation on growth and body
composition in children with sickle cell disease. Am J Clin Nutr.
2002 Feb;75(2):300-7. Zemel BSKawchak DAFung EBOhene-Frempong
KStallings VAAm J Clin Nutr. Sickle Cell Anemia
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001554/ Zinc
http://www.mayoclinic.com/health/zinc/NS_patient-zinc Hemoglobin
http://en.wikipedia.org/wiki/Hemoglobin#Types_in_humans Gropper S,
Smith J, Groff J. Advanced Nutrition and Human Metabolism. 5 th Ed.
2009. 489-491. Carter JP, Grivetti LE, Davis JT, Nasiff S, Mansour
A, Mousa WA, Atta AE, Patwardhan VN, Moneim MA, Abdou IA, Darby WJ.
Growth and sexual development of adolescent Egyptian village boys.
Effects of zinc, iron, and placebo supplementation. Am J Clin Nutr.
1969 January; 22(1): 5978. Platt OS, Rosenstock W, Espeland M.
Influence of Sickle Hemoglobinopathies on Growth and Development. N
Engl J Med 1984;311:7-12. Henderson RA, Saavedra JM, Dover GJ.
Prevalence of impaired growth in children with homozygous sickle
cell anemia. Am J Med Sci 1994;307:405-7. Kramer MS, Rooks Y,
Washington LA, Pearson HA, Pre- and post-natal growth and
development in sickle cell anemia. J Pediatr 1980;96:857-60
