ASSESSMENT OF SOME BIOCHEMICAL MARKERS OF NUTRITIONAL STATUS AMONG ADULT SICKLE CELL ANAEMIA PATIENTS IN STEADY STATE IN ZARIA

ABSTRACT

Sickle cell anaemia is a chronic haemolytic state which is characterized by hypercatabolism that could predispose to malnutrition. The low socio economic background of our patients may worsen their health status. The study was aimed atassessing some biochemical markers of nutritional status among adult sickle cell anaemia patients in steady state in Zaria. It is a cross-sectional descriptive study which was conducted in the Departments of Chemical Pathology and Haematology, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State. Some biochemical markers of nutritional status of 60 adult SCA patients in steady state and 60 healthy non SCA controls were assessed. Mean (±SEM) serum vitamin D concentration was significantly lower in SCA patients 14.55±1.49 ug/L compared with controls 25.87.±4.29 ug/L (p < 0.05). Mean (±SEM) serum calcium concentration was significantly lower in SCA patients 2.20 ±0.06 mmol/L compared with controls2.33±0.04 mmol/L (p < 0.05).Mean (±SEM) serum albumin concentration was significantly lower in SCA patients 33.40±1.66 g/L compared with controls 40.13.±0.85 g/L (p < 0.05).Mean (±SEM) serum inorganic phosphate concentration was significantly higher in SCA patients2.00.±0.13 mmol/L compared with controls 1.26±0.08 mmol/L (p < 0.05).The mean (±SEM)BMI Kg/m² was significantly lower in SCA patients 21.37±0.35 Kg/m² compared with controls 23.27 Kg/m² (p < 0.05). The study also showedno correlations between BMI and the biochemical markers measured in both SCA patients and controls.

In conclusion, mean sera concentrations of vitamin D, calcium and albuminamong adult SCA patients in steady state were lowcompared with controls, so also BMI. The meanserum concentration of inorganic phosphate however, was significantly higher in SCA than in the control subjects. There wereno correlations between BMI and biochemical markers measured in thestudy population. Therefore SCA patients in steady state are more malnourished when compared to the controls.

CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Sickle cell anemia (SCA) is a genetic disease that results from the substitution of valine for glutamic acid in the β-globin chain of the hemoglobin molecule (Pauling and Itano, 1949). The consequence of this amino acid substitution is the formation of hemoglobin S (HbS). Under low oxygen tension and/or conditions of acidosis. HbS precipitates and forms polymerized crystals called tactoids (hemoglobin polymers), which distort the red blood cells (Nelson and Cox, 2005; Ganong, 2003). The resulting sickle-shaped red cells lose their pliability and cannot navigate the small capillaries, become sticky, and adhere to the small veins, small arteries, and other blood vessels causing vaso-occlusion (Aster, 2005; Bunn and Forget, 1977). In addition, red blood cells homozygous for HbS (HbSS) are susceptible to premature destruction, with a red blood cell life span of 8–25 days as compared to 100–120 days for normal red blood cells (Solankiet al, 1988).

In the last few decades, studies have documented the presence of micro- and macronutrient deficiency among individuals with SCA and their possible association with immunologic, nutritional and growth abnormalities (Heymanet al.,1985; Gray et al., 1992; Serjeant et al., 2001). Patients with sickle cell anemia (SCA) have low bone mass compared to healthy subjects (Lalet al, 2006). Low bone mass in these patients is apparent even after adjusting for age, height, pubertal development, and lean body mass, suggesting that the deficits cannot be fully explained by short stature, delayed puberty, or altered body composition. Chronic haemolytic anemia and the resulting erythroblastic hyperplasia may contribute to bone demineralization in SCA (Serjeant and Serjeant, 2001). Furthermore, reduced physical activity, decreased circulating growth hormone, vitamin D deficiency and poor dietary intake of bone-forming nutrients are likely contributing factors (Buisonet al, 2004). Suboptimal peak bone mass acquisition in childhood may contribute to the development of osteoporosis in later life (Heanyet al, 2002).

Studies using direct measure of nutritional status (Enwonwu and Lu, 1991; Gray et al., 1992; Kennedy et al., 2001), indirect assessment of nutritional status (Henderson et al., 2005), and application of nutritional supplementation (Prasad and Cossack, 1984, Heymanet al., 1985), have established the association between SCA and the presence of nutritional deficiency among patients with the disease. These studies showed that although intake might be sufficient when measured against the recommended daily dietary allowance for age and sex, it is still insufficient for the individual with SCA due to the increased nutritional demand imposed by the disease. The result was the manifestation of malnutrition-like features (Prasad, 1997; Al-Saqladiet al, 2008; Hyacinth, et al, 2010).

1.2 STATEMENT OF THE PROBLEM

Nutritional deficiencies have not been given serious consideration in the assessment of SCA patients in this environment. It will be essential for physicians to adopt a nutritional approach as a part of the management modality for SCA in the light of the fact that more than two-thirds of the patients with SCA live in areas with low socioeconomic status and have little to no means of accessing the current methods of management.  Therefore  the  present  study  is  aimed  at  assessing  some  biochemical markers of nutritional status in this group of patients.

1.3       JUSTIFICATION OF THE STUDY

The assessment of nutritional status in SCA patients could improve in the management of their conditions.

1.4       AIM AND OBJECTIVES OF THE STUDY

Aim

To assess some biochemical markers of nutritional status among adult SCA patients in steady state in Zaria.

Objectives

The objectives of this study were as follows:

1. To determine serum levels of vitamin D, calcium, phosphate and albumin in adult SCA patients in steady state in Zaria and HbAA controls.

2. To compare the serum levels of vitamin D, calcium, phosphate and albumin obtained from adult SCA patients in steady state and apparently healthy non SCA HbAA controls.

3. To determine the anthropometric parameters of adult SCA patients in steady state and HbAA controls.

4. To correlate the anthropometric parameters with serum levels of vitamin D, calcium, phosphate and albumin obtained from the study population.

1.5       RESEARCH HYPOTHESIS

H0: Sickle cell anaemia does not affect nutritional status (Null hypothesis).

H1: Sickle cell anaemia affects nutritional status (Alternate hypothesis).

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Item Type: Project Material  |  Size: 103 pages  |  Chapters: 1-5

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