ESPE Abstracts

Introduction:Blood transfusion and iron chelation are conventional treatments for β-thalassemia (BTM). Malnutrition negatively affects their growth, efficacy of treatments, and quality of life.

Objective: To evaluate the nutritional status and linear growth in 10 countries in the past 20 years.

Methods: We performed an electronic search in PubMed, Google Scholar, and Web of Sciences to evaluate the prevalence of malnutrition in children and adults with BTM

Results:Ten studies were included from 10 Mediterranean and Middle East countries after 2000. The total number of patients was 2036 children reported from 10 countries (Greece, Turkey, Pakistan, India, Thailand, Bangladesh, Egypt. Iran, and Iraq) . Undernutrition (Low WAZ, low BMIZ, low WLZ) occurred in a considerable number of children and adolescents (42.2%). The prevalence varies greatly among different countries (from 20% to 71%). This great variability can be explained by the income/nutritional status of each country. The developing (lower middle income) countries (India, Pakistan, Iran, Egypt) had the higher prevalence versus the high -middle and high income (Turkey, Greece). In addition, abnormal body composition including reduced muscle mass, lean body mass, and Bone mineral density (osteopenia) occurred in BTM patients even those with normal BMI. Thalassemic children and adolescents had low levels of circulating nutrients which signifies either nutrient excretion or loss, or higher micronutrient requirements. The energy intake appears to be low (65 to 75% of the RDA) in a good number of these patients. They have a high prevalence of vitamin D, alpha-tocopherol, retinol, zinc, selenium, and copper deficiencies versus controls. Being Underweight is associated with short stature in a good number of thalassemic children and adolescents. Underweight and short stature can be explained by many contributing pathologies. These include poor transfusion regimen (tissue hypoxia), poor chelation with iron toxicity, high prevalence of endocrinopathies (disturbed GH-IGF1 axis, low insulin secretion and/or insulin resistance, delayed or absent puberty, reduced physical activity, lack of maternal education, and psychosocial stress.

Conclusions: In thalassemic children and adolescents nutritional stunting and change in body composition can partially result from reduced nutrient intake. Proper blood transfusion and effective chelation therapy, in addition to nutritional surveillance and support, are important to maintaining normal linear growth and weight gain.