Assessing Nutrition Knowledge and Nutritional Status of Sickle Cell Disease Patients

Abstract

Background: Sickle cell disease (SCD) is a common haemoglobinopathy that is acquired by inheriting the defective gene from both parents. In recent years, it has become an important public health issue among people of African descent especially those in Sub-Saharan Africa. In Ghana, SCD occurs in almost 1 in 50 (2%) of all births annually. The disease is characterised by chronic haemolytic anaemia, vaso-occlusion and inflammation. These events increase the resting energy expenditure of individuals and contribute to the hypermetabolic state of a sickle cell patient, and consequently impact on the nutritional status. The poor nutritional status reported in individuals with SCD can also be attributed to reduced dietary intake due to low appetite leading to varied nutrient deficiencies including vitamin A, C, E and D deficiencies. In spite of these nutritional challenges faced by this group of people, frequent nutritional counselling is not part of the standard of care. However, recent studies have identified nutrition knowledge as one of the mechanisms which influence nutritional behaviour of individuals thereby improving their nutritional status. Aim: To assess nutritional knowledge and nutritional status of people with sickle cell disease. Methods: A cross-sectional study design was used. An estimated number of 173 adolescents and adults attending the Ghana Institute of Clinical Genetics, Korle Bu who were recruited for the SickleGenAfrica project were enrolled for this study. Nutrition knowledge of patients was assessed using a pre-tested questionnaire. Anthropometric, biochemical data and a oneweek food frequency questionnaire were used to assess nutritional status. About 0.15ml of serum for the SickleGenAfrica project was sampled to assess serum vitamin E and IL-6 levels using Enzyme Linked Immunoassay technique. Stata/IC 14.0 was used for data analysis. Chisquared was used to test for associations between nutrition knowledge and nutritional status. Linear regression was used to determine association between inflammation and nutritional status. Multiple regression was used to test for the strength of the significant associations. A p-value < 0.05 was considered statistically significant. Results: Malnutrition was recorded among 25% of the participants with prevalence of underweight, overweight and obesity as 15.2%, 7.6% and 1.8% respectively. Majority (84.8%) of the participants had high nutrition knowledge. There was no association between nutritional knowledge and nutritional status. The frequency of fruits and vegetables consumption was low. The mean serum vitamin E level of participants was 6.7±9.9μg/ml and there was no significant difference between mean levels of Hb SS and Hb SC individuals. Even in steady state, IL-6 levels were elevated with a mean of 18.6±33.7 pg/ml and this correlated negatively with body weight (r = -0.1698, p = 0.03). Body weight and height could predict 3% of the variability in IL-6 levels (F (2, 165) = 2.97; p – 0.05). There was a significant difference between the IL-6 levels of Hb SS and Hb SC individuals with means of 21.4±3.42 pg/ml and 11.2±2.70 pg/ml (p - 0.02) respectively. Conclusion: Nutrition knowledge did not influence nutritional status. Results from this study show that participants are at risk of vitamin E deficiency. Hb SS individuals experienced higher levels of inflammation compared to Hb SC individuals.