Abstract:
Background: Sickle cell disease (SCD) is an inherited blood disorder that predominantly affects individuals in sub-
Saharan Africa. However, research that elucidates links between SCD pathophysiology and nutritional status in
African patients is lacking. This systematic review aimed to assess the landscape of studies in sub-Saharan Africa
that focused on nutritional aspects of SCD, and highlights gaps in knowledge that could inform priority-setting for
future research.
Methods: The study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis
(PRISMA) guidelines. Inclusion criteria comprised original, peer-reviewed research published between January 1995
and November 2020 involving individuals in Africa with any phenotypic variant of SCD and at least one nutritional
status outcome. Nutritional status outcomes were defined as those that assessed dietary intakes, growth/
anthropometry, or nutritional biomarkers. Databases used were Ovid Embase, Medline, Biosis and Web of Science.
Results: The search returned 526 articles, of which 76 were included in the final analyses. Most investigations (67%)
were conducted in Nigeria. Studies were categorized into one of three main categories: descriptive studies of
anthropometric characteristics (49%), descriptive studies of macro- or micronutrient status (41%), and interventional
studies (11%). Findings consistently included growth impairment, especially among children and adolescents from
sub-Saharan Africa. Studies assessing macro- and micronutrients generally had small sample sizes and were
exploratory in nature. Only four randomized trials were identified, which measured the impact of lime juice, longchain
fatty acids supplementation, ready-to-use supplementary food (RUSF), and oral arginine on health outcomes.
Conclusions: The findings reveal a moderate number of descriptive studies, most with small sample sizes, that
focused on various aspects of nutrition and SCD in African patients. There was a stark dearth of interventional
studies that could be used to inform evidence-based changes in clinical practice. Findings from the investigations
were generally consistent with data from other regional settings, describing a significant risk of growth faltering
and malnutrition among individuals with SCD. There is an unmet need for clinical research to better understand
the potential benefits of nutrition-related interventions for patients with SCD in sub-Saharan Africa to promote
optimal growth and improve health outcomes
