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 |