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Table 2 Studies of macronutrient or micronutrient levels in 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 Nutrient type Findings
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 Proteins/amino acids • No significant differences in concentrations of total protein, albumin, serum creatinine, or albumin/globulin ratios
• Significantly reduced serum prealbumin levels in individuals with SCD
• Significantly reduced serum concentrations of all essential amino acids and most non-essential amino acids (exceptions: alanine, glutamic acid, proline) in individuals with SCD
Cox et al., 2011 [59] Dar-es-Salaam, Tanzania Mean 17–18 years 11 patients who had succumbed 12 age- and gender-matched controls (all patients had SCD; comparison was between those alive and those who had succumbed) Proteins/amino acids • Significantly lower BMI, a trend for lower taurine levels, and significantly lower l arginine bioavailability in individuals with SCD who later succumbed
• No differences in hemolytic markers (unconjugated bilirubin, lactate dehydrogenase, aspartate transaminase, alkaline phosphate), with the exception that conjugated bilirubin at enrollment was significantly higher in patients who later succumbed compared to those who did not
Enomoto et al., 1998 [60] Jos, Nigeria Females mean 6.3 years; males mean 6.8 years 13 14 age-matched controls Fatty acids • No difference in proportions of linoleic and α-linolenic fatty acids
• Significantly increased levels of palmitic acid and oleic acid in individuals with SCD
• Significantly reduced levels of arachidonic acid, eicosapentanoic acid, and decosahexanolc acid
Glew et al., 2002 [61] Jos, Nigeria 5–17 years (mean 13 years) 77 73 age- and gender-matched controls Fatty acids • No differences in levels of linoleic acid
• Significantly reduced α-linolenic acid and arachidonic acid in females with SCD; no difference in males
• Significantly reduced eicosapentanoic acid and docosahexaenoic acid in individuals with SCD
• Significantly increased proportions of palmitic acid (16:0) and oleic acid (18:1n-9) in serum phospholipids in individuals with SCD
VanderJagt et al., 2002 [26] Jos, Nigeria Females mean 13.2 years; males mean 13.4 years 72 68 age- and gender-matched controls Fatty acids • No differences in linoleic and α-linolenic acid
• Significantly reduced long chain polyunsaturated fatty acids and arachidonic acid in individuals with SCD
• Significantly higher palmitic acid and oleic acid in individuals with SCD
Glew et al., 2003 [29] Jos, Nigeria 9–20 years (mean 14 years for males; mean 13 years for females) 77 75 age- and gender-matched healthy controls Fatty acids • Significantly reduced linoleic acid, arachidonic acid, α-linolenic acid, eicosapentanoic acid, and docosahexaenoic acid in serum cholesterol esters in individuals with SCD
• Significantly increased palmitic acid and oleic acid in serum cholesterol esters in individuals with SCD
Hamdy et al., 2015 [62] Cairo, Egypt 6–18 years (mean 12 years) 30 30 age- and gender-matched controls Fatty acids and vitamins • Significantly reduced cholesterol, triglycerides, and LDL in individuals with SCD
• No differences in HDL
• Significantly reduced levels of selenium and vitamin E in individuals with SCD
Ren et al., 2008 [63] Enugu, Nigeria 11–43 years 26 30 HbAA individuals aged 22–53 years Fatty acids and vitamins • Significantly reduced eicosapentanoic acid and docosahexaenoic acid in red blood cell choline phosphoglycerides in individuals with SCD
• Significantly reduced plasma retinol, α-tocopherol, and β-carotene concentrations, and reduced activity of red cell copper/zinc-superoxide dismutase, in individuals with SCD
Shukla et al., 1999 [64] Malawi 2–19 years (mean 9 years) 28 No control group; comparisons with normal range (< 8.0 μmol/L) Vitamins • Reduced vitamin E levels in 12 children (63%)
• Reduced vitamin E/cholesterol ratio in 10 children (36%), indicating vitamin E deficiency
Jiya et al., 2005 [65] Sokoto, Nigeria 9 months – 12 years (mean 6 years) 27 with HbSS and 11 with HbSS and persistent fetal hemoglobin 32 age- and gender-matched controls Vitamins • Significantly lower vitamin A (retinol), vitamin C (ascorbic acid) and vitamin E (α-tocopherol) in individuals with SCD
Cox et al., 2011 [66] Tanzania 2–15 years (median 8 years) 23 18 siblings aged 2–12 years (median 7 years) Vitamins Vitamin C deficiency identified in 48% of individuals with SCD
Tsang et al., 2014 [40] Nyanza Province, Western Kenya 6–35 months 14 288 individuals from a random sample of 882 Vitamins • No significant association with vitamin A deficiency
Adegoke et al., 2017 [67] Ile-Ife, Nigeria Mean age 7 years 95 75 age- and gender-matched HbAA individuals Vitamins Significantly reduced mean serum 25-hydroxy vitamin D in individuals with SCD
Adegoke et al., 2017 [48] Ilesa, Nigeria 4–11 years (mean 7 years) 95 109 Brazilian children with SCD aged 4–11 years (study compares SCD populations in Nigeria and Brazil) Vitamins • Suboptimal vitamin D levels in 12.6% of Nigerian individuals with SCD; none had severe vitamin D deficiency
Adegoke et al., 2017 [68] Nigeria 1–15 years (mean 8 years) 123 Study examined effect of vitamin D levels on pain (no control group) Vitamins • Deficient or insufficient serum 25-hydroxyvitamin D (vitamin D) in 11% of individuals with SCD; none had severe vitamin D deficiency
Siegert et al., 2018 [69] Uganda 1–4 years 99 individuals with SCD randomly selected from the NOHARM study [70] Compared with standard reference values Vitamins • 53% of children were vitamin D-insufficient (unrelated to inflammation)
• Prevalence of vitamin deficiency: vitamin A (18%), vitamin B12 (3%), vitamin D (6%), vitamin E (1%)
Ajayi et al., 1997 [71] Lagos, Nigeria Mean 21 years 30 (females only; 10 HbSS, 10 HbAS, 10 HbAC) 10 HbAA individuals Minerals • Significantly reduced zinc levels in individuals with SCD compared to heterozygotes and HbAA controls
• Significantly reduced mean serum and erythrocyte copper in individuals with SCD compared to heterozygotes and HbAA controls
• Significantly reduced serum, erythrocyte, and urine magnesium in individuals with SCD compared to heterozygotes and HbAA controls
Akenami et al., 1999 [72] Ibadan, Nigeria 16–42 years 35 (23 HbSS, 12 HbSC) 25 age- and gender-matched HbAA individuals Minerals • Significantly reduced serum zinc in individuals with HbSS and HbSC
• Significantly increased serum copper and magnesium in individuals with HbSS; no difference in individuals with HbSC
Oladipo et al., 2005 [73] Lagos, Nigeria 7–170 months 86 45 age- and gender-matched HbAA individuals Minerals • Significantly increased serum phosphorus in individuals with SCD
• Significantly reduced serum calcium in individuals with SCD
• No differences in serum magnesium and albumin
Ojo et al., 2006 [74] Ile-Ife, Nigeria 10–60 years 84 (divided by multiple methods of analysis and sample sites) 141 (divided by multiple methods of analysis and sample sites) Minerals • Elevated erythrocyte sodium in individuals with SCD
• Significantly reduced potassium, zinc, iron, and riboflavin in whole blood and/or erythrocytes in individuals with SCD
Arinola et al., 2008 [75] Ibadan, Nigeria Not stated 20 individuals with HbSS without malaria; 24 individuals with HbSS with malaria 18 HbAA individuals with malaria; 32 HbAA individuals without malaria Minerals • Significantly reduced iron, zinc, and magnesium in individuals with SCD compared to controls
• Significantly increased urea in non-malaria infected individuals with SCD compared with non-malaria infected controls
• Significantly reduced levels of total antioxidants in non-malaria infected individuals with SCD compared with non-malaria infected controls
• No differences in magnesium, copper, chromium, cadmium, and selenium in non-malaria infected individuals with and without SCD
• No differences in levels of serum albumin
Olaniyi et al., 2010 [76] Ibadan, Nigeria 26–55 years 59 35 age- and gender-matched controls Minerals • Significantly increased mean plasma levels of zinc and nitric oxide in individuals with SCD
• Significantly reduced levels of serum iron, chromium, and selenium in individuals with SCD
• No differences in levels of magnesium, manganese, and copper
Cox et al., 2012 [77] Tanzania 3–15 years (mean 8 years) 32 No control group Minerals Nocturnal hemoglobin oxygen desaturation in individuals with SCD associated with higher transferrin saturation
Onukwuli et al., 2017 [52] Enugu, Nigeria 6–18 years 81 (females only) 81 age- and socioeconomic class-matched HbAA individuals from outpatient clinic Minerals Significantly reduced levels of serum zinc in individuals with SCD
Sungu et al., 2018 [78] Kasumbalesa, Democratic Republic of Congo 2–15 years (mean 10 years) 76 76 age-, gender-, and residence area-matched controls Minerals Significantly reduced levels of zinc and magnesium in individuals with SCD
Lee et al., 2018 [79] Tanzania 3–18 years 199 No control group Minerals Lower hepcidin in more severely anemic individuals with SCD
Ajibola et al., 2019 [80] Osun State, Nigeria Median age 24 years 60 individuals with phenotypes SS or SC 83 HbAS or HbAC individuals; 50 HbAA individuals Minerals • Malondialdehyde and superoxide dismutase significantly higher in Hb variants compared to controls
• Glutathione and total antioxidant stats levels significantly reduced in Hb variants
• Overall results suggested that SCD patients & carriers were more vulnerable to oxidative stress
Emokpae et al., 2019 [81] Benin City, Nigeria 4–20 years 100 HbSS individuals 50 age- and gender matched HbAA individuals Minerals Significantly higher serum copper levels and significantly lower zinc levels in individuals with SCD compared to controls
Antwi-Boasiako et al., 2019 [82] Accra, Ghana Mean ages ranged 21–38 years old (depending on phenotype) 90 HbSS and HbSC individuals 50 HbAA individuals Minerals • Significantly higher serum iron and copper in individuals with SCD compared to controls
• Serum iron and copper were further increased in patients with HbSS and vaso-occlusive crises
• Serum zinc levels were significantly lower in individuals with SCD, especially during vaso-occlusion
Kudirat et al., 2019 [83] Kano, Nigeria 6 months-15 years 140 (70 with acute pain crises, 70 in steady state) 70 HbAA individuals Minerals Significantly lower serum zinc level in individuals with SCD compared to controls, which was made worse during vaso-occlusive crises
Erhabor et al., 2019 [84] Sokoto, Nigeria 1–15 years 45 25 age-matched HbAA individuals Minerals Significantly lower mean serum copper and selenium in individuals with SCD