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Table 1 Studies of anthropometric characteristics of individuals living with sickle cell disease in Africa

From: Nutritional perspectives on sickle cell disease in Africa: a systematic review

Authors and year of publication Location Ages No. of subjects Control group Weight Height Body mass index Other assessments
VanderJagt et al., 1997 [22] Jos, Nigeria 10 months-14 years (mean 7 years for males; mean 6 years for females) 13 17 age- and gender-matched controls Significantly lower weight in males with SCD No significant differences in height reported No statistical difference in BMI as both weight and height were lower for SCD patients • Significantly lower head circumference in males with SCD versus controls
• No differences in MUAC or triceps skin fold
• No differences reported for females
Soliman et al., 1999 [23] Alexandria, Egypt Mean 7 years 110 200 healthy age-matched children, 30 children with constitutional growth delay, 25 children with growth hormone deficiency N/A • Height and growth velocity significantly lower in SCD patients than healthy controls
• Bone age delay in SCD patients by 2.4 years
• BMI not significantly different between SCD patients and healthy controls • Lower MUAC and triceps skin fold thickness in SCD patients versus healthy controls
• Significant age delays in puberty in SCD patients
Aderibigbe et al., 1999 [24] Ilorin, Nigeria 18–54 years (mean 22 years) 64 60 adults aged 18–57 Significantly lower weight in individuals with SCD Significantly shorter height in individuals with SCD N/A  
VanderJagt et al., 2000 [25] Jos, Nigeria 3–20 years 48 51 healthy controls Significantly lower weight in males with SCD aged 10–18 years; no differences for females No differences Significantly lower BMI for males with SCD aged 10–18; no differences for females • Significantly lower fat free mass in males with SCD aged 10–18
• Significantly higher body fat and % body fat in individuals with SCD aged > 10 years
Vandegt et al., 2002 [26] Jos, Nigeria Mean 13 years for males and females 72 68 age- and gender-matched controls Significantly lower weight in females and males with SCD Significantly lower height in females and males with SCD Significantly lower BMI in females and males with SCD  
VanderJagt et al., 2002 [27] Jos, Nigeria 8–22 years (mean 14 years for males; mean 13 years for females) 80 41 male and 38 female age-matched controls; 51 male and 71 female additional controls for ultrasound component Significantly lower weight in females and males with SCD Significantly lower height in females and males with SCD Significantly lower BMI in males and females with SCD • Significantly lower bone density in individuals with SCD by ultrasound measurement
• Some differences in serum markers of bone resorption and formation
• No differences in triceps skin fold
• Significantly lower MUAC, FFM, and % FFM in males and females with SCD; males with SCD also had significantly lower body fat
Oredugba et al., 2002 [28] Lagos, Nigeria 1–18 years (mean 10 years) 117 122 children and adolescents aged 1–18 years from well-baby clinics and surgical outpatient unit Significantly lower weight in individuals with SCD aged 18 years No differences N/A • Significantly lower MUAC in individuals with SCD
• No differences in mean head circumference
Glew et al., 2003 [29] Jos, Nigeria 10–18 years (mean 14 years for males; mean 13 years for females) 77 75 age- and gender-matched controls Significantly lower weight in individuals with SCD Significantly lower height in individuals with SCD Significantly lower BMI in males with SCD; no differences for females  
VanderJagt et al., 2007 [30] Jos, Nigeria 7–35 years (mean 15 years for males; mean 17 years for females) 102 104
healthy age and gender matched controls
Significantly lower weight in individuals with SCD • Significantly lower mean sitting height in individuals with SCD
• Significantly lower standing height in males with SCD (not significantly different for females)
Significantly lower BMI in females with SCD; no differences for males • Significantly lower FFM in individuals with SCD; no differences in FFM% and fat %
• Significantly lower phase angle (measure of overall nutritional status) in individuals with SCD
• Significantly lower MUAC and triceps skin fold in females with SCD (not for males)
Aina et al., 2010 [31] Lagos, Nigeria 10–19 years (mean 14 years) 136 136 age- and gender-matched controls N/A N/A N/A Delayed puberty in males and females with SCD
Cox et al., 2011 [32] Dar es Salaam, Tanzania 6 months-48 years (mean 10 years) 1041 717 HbAA siblings, clinic walk-ins, and referrals SCD status was significantly associated with underweight; adult males were more likely to be underweight than females SCD was significantly associated with stunting; adult males were more likely to be stunted than females SCD was significantly associated with wasting; adult males were more likely to have wasting than females  
Osei-Yeboah, 2011 [33] Ghana 1–12 years (mean 7 years) 357; phenotype included SS, SC, SD, S Beta thal 70 HbAA siblings • Significantly lower weight-for-age in individuals with SCD
• Prevalence of malnutrition higher in individuals with SCD (61%) versus controls (29%)
• No significant differences in rates of wasting (weight-for-height)
Prevalence of stunting higher in individuals with SCD (35%) versus controls (3%) N/A  
Iwalokun et al., 2011 [34] Lagos, Nigeria 5–35 years 55 (31 steady-state and 24 unstable/ crisis) 22 “non-SCD” individuals Significantly lower weight for males > 16 years; not different in other age groups N/A Significantly lower BMI in females with SCD (all age groups) and males with SCD (> 16 years) • Significantly lower fat mass in males with SCD (> 16 years); not significantly different for other age groups
• Significantly lower leptin levels in males with SCD (≤16 years) and all female age groups
Animasahun et al., 2011 [35] Lagos, Nigeria 1–10 years (mean 6 years) 100 100 individuals with phenotype HbAA matched by age, socio-economic class, and gender Significantly lower mean weight and weight-for-height in individuals with SCD Mean height showed no difference between SCD patients and controls No difference in mean BMI  
Akodu et al., 2012 [36] Lagos, Nigeria 2–15 years (mean 8 years) 80 80 individuals with phenotype HbAA No statistical difference reported N/A Significantly lower BMI in individuals with SCD  
Tebbani et al., 2014 [37] Annaba city, Algeria 6–12 years 30 WHO standard references Lower weight in individuals with SCD compared with WHO standards Height was below WHO standard references for SCD patients N/A  
Akingbola et al., 2014 [38] Ibadan, Oyo, Nigeria and Chicago, USA 11–30 years 214 209 individuals with SCD aged 11–30 years living in USA (compares characteristics of individuals with SCD in Nigeria to those in US) Significantly lower weight in individuals with SCD in Nigeria vs US in patients ≥18 years old Significantly lower height in individuals with SCD in Nigeria vs US in patients ≥18 years old Significantly lower BMI in individuals with SCD in Nigeria vs US in patients ≥18 years old  
Akodu et al., 2014 [39] Lagos, Nigeria 8 months-15 years (mean 6 years) 100 100 HbAA age- and sex-matched controls N/A Significantly lower sitting height in individuals with SCD aged > 10 years; height not significantly different N/A Significantly shorter arm span in individuals with SCD aged > 10 years
Tsang et al., 2014 [40] Nyanza Province, Western Kenya 6–35 months 14 288 children from random sample of 882; Underweight, stunting and wasting were defined using WHO 2006 standards No significant association of HbSS with underweight No significant association of HbSS with stunting No significant association of HbSS with wasting  
Eke et al., 2015 [41] Enugu, Nigeria 6–18 years (mean 11 years) 132 132 age- and gender-matched HbAA children and adolescents from nearby schools Significantly lower weight in females with SCD aged 10–18 years; no differences in males No differences Significantly lower BMI in females with SCD aged 10–18 years; no differences in males • No differences in body fat % or visceral fat %
• Significantly lower skeletal muscle % in males with SCD aged 6–9 years
Eke et al., 2015 [42] Enugu, Nigeria 1–5 years (mean 3 years) 58 58 age- and gender-matched HbAA individuals • Significantly lower weight-for-age in individuals with SCD
• Significantly lower rate of obesity in individuals with SCD (3.4% vs 22.4%)
No difference in height-for-age Significantly lower BMI in individuals with SCD • Significantly lower weight-for-height in individuals with SCD
Ranque et al., 2016 [43] Cameroon, Ivory Coast, Gabon, Mali, Senegal 10–24 years (median 16 years) 3627 943 controls aged 14–33 years; controls were significantly older (median age 24 years versus 16 years for SCD patients) and more likely to be female (60% vs 54%) N/A Significantly lower height in individuals with SCD Significantly lower BMI in individuals with SCD  
Odetunde et al., 2016 [44] Enugu State, Nigeria 6–20 years (mean 12 years) 40 40 age-, gender-, socioeconomic status-matched HbAA individuals from area schools Significantly lower weight in individuals with SCD No differences in height 48% with SCD were underweight (BMI < 5th percentile); 13% of controls were underweight  
Esezobor et al., 2016 [45] Lagos, Nigeria 2–17 years (mean 9 years) 233 Compared with WHO 2007 standards 23% of individuals with SCD had wasting (low weight-for-height) or severe wasting 12% of SCD patients were stunted or severely stunted; 75.5% were normal height 2% of individuals with SCD were overweight or obese  
Senbanjo et al. 2016 [46] Lagos, Nigeria Children up to age 15 years (mean 7 years) 118 (114 HbSS and 4 HbSC phenotype) 118 age-, gender-, and socioeconomic class-matched; stunting/malnutrition based on WHO 1995 standards Significantly higher rate of “thinning” in individuals with SCD aged 11–15 years Significantly higher rate of stunting in individuals with SCD aged 11–15 years N/A No overall difference in mean head circumference
Oluwole et al., 2016 [47] Lagos, Nigeria 6–16 years (mean 9 years) 56 44 individuals without SCD Significantly lower weight-for-age in individuals with SCD Significantly lower height in individuals with SCD Significantly lower BMI in individuals with SCD  
Adegoke et al., 2017 [48] Ilesa, Nigeria 4–11 years 95 109 Brazilian children with SCD aged 4–11 years; 36 were hydroxyurea (HU)-naive to match Nigerian patients (study compares SCD populations in Nigeria and Brazil) 30% of SCD patients in Nigeria had low weight-for-height; 4.3% were overweight or obese 13% of SCD patients in Nigeria were of short stature; 8.4% were tall for age; significantly lower mean height-for-age among Nigerian patients compared with Brazilian HU-naive patients Significantly lower BMI in Nigerian individuals with SCD Significantly lower triceps skin fold, upper arm area, upper arm muscle area, and fat % among Nigerian patients compared with the Brazilian HU-naive patients
Mikobi et al., 2017 [49] Kinshasa, Democratic Republic of Congo Mean 25 years 140 Study compared groups of SCD patients stratified by disease severity N/A N/A Significantly lower BMI in patients with greater disease severity  
Kazadi et al., 2017 [50] Kinshasa, Democratic Republic of Congo Under 12 years 159 296 age-, gender-, and neighborhood-matched individuals with HbAA; comparisons focused on children under age 12 years; underweight, stunting and wasting were defined using WHO 2006 standards Significantly lower weight in individuals with SCD (39.6% of individuals with SCD versus 12.2% of controls) Significantly more stunting in individuals with SCD (34.6% in individuals with SCD versus 9.8% of controls) N/A Factors significantly associated (P < 0.01) with poor growth included frequency of crises, age < 1 yr. at first transfusion, and hand-foot syndrome
Sokunbi et al., 2017 [51] Nigeria 5–18 years (mean 9 years) 175 175 age-matched HbAA individuals No statistical difference reported Significantly lower height in individuals with SCD No statistical difference reported  
Onukwuli et al., 2018 [52] Enugu, Nigeria 6–18 years (females only) 81 (females only) 81 age- and socioeconomic class-matched HbAA individuals recruited from outpatient clinic Significantly lower mean weight in individuals with SCD No differences in mean height Significantly lower BMI in individuals with SCD  
Osei et al., 2019 [53] Kumasi, Ghana 3–12 years 100; phenotypes included SS, Sβ0, SC, Sβ+ Compared with WHO growth standards 37% of individuals with were underweight 22% of individuals with SCD were stunted   
Sap Ngo Um et al., 2019 [54] Yaoundé, Cameroon 2–5 years 77 Compared with WHO growth standards 4% of subjects were underweight and 5% of subjects were wasted 4% of subjects were stunted   Trend towards higher rates of underweight, wasting, and stunting with increasing age
Alexandre-Heymann et al., 2019 [55] Cameroon, Ivory Coast, Gabon, Mali, Senegal 5–21 years 2583; phenotypes included SS, Sβ0, SC, Sβ+ 287 HbAA or HbAS individuals See “other assessments” See “other assessments” See “other assessments” • The primary outcome of “growth failure” was defined as a height and/or weight and/or BMI below the 5th percentile on WHO 2007 growth charts.
• Signifcantly higher rates of growth failure found in individuals with SS and Sβ0 phenotypes
• Growth failure not found to be correlated with history of SCD-related medical complications
• Differences in growth failure rates most pronounced in males aged 15–17 years
Arigliani et al., 2019 [56] Kaduna, Nigeria 6–18 years 154 364 age-matched controls Significantly increased rate of wasting in individuals with SCD Significantly increased rate of stunting in individuals with SCD   
Arigliani et al., 2019 [57] Kinshasa, Democratic Republic of Congo 6–18 years 112 377 schoolchildren controls Significantly increased rate of wasting in individuals with SCD Significantly increased rate of stunting in individuals with SCD   
Ukoha et al., 2020 [58] Enugu, Nigeria 1–18 years 175 175 age-, gender-, and socioeconomic status-matched HbAA individuals Significantly lower Z-score for weight-for-age in individuals with SCD, and significantly higher rate of wasting in individuals with SCD (using WHO growth references) Significantly lower Z-score for height-for-age in individuals with SCD, and significantly higher rate of stunting in individuals with SCD (using WHO growth references) Significantly lower Z-score for BMI-for-age in individuals with SCD