1. Ema Thake Graduate Seminar 2011 NUTR 6400 Can zinc supplementation address growth restriction in children with Sickle Cell Anemia?

2. What is Sickle Cell Anemia? A hereditary disease in which red blood cells are abnormally shaped like a crescent instead of in the shape of a full disc.

3. Causes Sickle cell anemia is caused by hemoglobin S, an abnormal form of hemoglobin

4. Diagnosis Patients are usually diagnosed around 4 months of age. Tests for diagnosis can include: CBC Hemoglobin electrophoresis Serum hgb, serum WBC Bilirubin, Serum creatinine Sickle Cell Test Looks for sickle shaped blood cells (abnormal hemoglobin)

5. Symptoms Symptoms can include: Attacks of abdominal pain Bone pain Breathlessness Jaundice Other symptoms: chest pain, polydypsia, polyuria, stroke, skin ulcers, poor eyesight, blindness Delayed growth and puberty

6. Treatment There is no cure for sickle cell anemia In the past, sickle cell patients often died between ages 20-40 due to organ failure. Patients are in need of ongoing treatment Folic acid supplements Antibiotics Pain medication Plenty of fluids Treatment for any complications from SCD

7. Growth restriction in children with sickle cell anemia Henderson et al. 63 patients with sickle cell anemia were assessed for growth 25% of subjects were less than the 5 th percentile of National Center for Health Statistics growth standards for either height/age, weight/age, or weight/height.

8. Zinc Important in many biological functions: Energy metabolism, protein synthesis, collagen formation, alcohol detoxification, carbon dioxide elimination, sexual maturation, taste and smell functions.

9. Zinc Deficiency Symptoms: Poor wound healing, subnormal growth, anorexia, changes in hair, skin, and nails Low plasma zinc levels are associated with poor growth status versus normal plasma zinc levels. Previous studies have linked zinc deficiency to growth abnormalities in children with SCD. (Zemel et al.)

10. Problem Most treatments of sickle cell anemia are focused on pain management. Providing dietary intervention by supplementation zinc may address growth problems in this population

11. Purpose Examine the effects of zinc supplementation and growth in children with sickle cell anemia.

12. Babette S Zemel, Deborah A Kawchak, Ellen B Fung, Kwaku Ohene-Frempong, and Virginia A Stallings Am J Clin Nutr 2002;75:300-7 Effect of zinc supplementation on growth and body composition in children with sickle cell disease

13. Study Design 12 month, randomized, placebo-controlled study of zinc supplementation in children aged 4-10 years old with sickle cell anemia. 42 children (20 girls, 22 boys) with SCD, ages 4-10 years old, were randomly assigned to receive 10mg supplemental zinc or placebo. After randomization, subjects received either 10mg elemental Zn in 5 ml of cherry syrup or 5 ml cherry syrup alone per day.

14. Methods Complete anthropometric assessments were completed at baseline, 3, 6, and 12 months. Body composition was assessed using DXA at baseline, 6, and 12 months. Dietary intake was assessed by conducting 24-hour recall interviews at baseline, 3, 6, and 12 months. Fasting blood samples were collected at baseline, 3, 6, and 12 months to assess plasma zinc concentration. 6 subjects (15% of sample size) had low serum zinc concentrations

16. Results

17. Discussion Children born with SCD seem normal at birth, but develop significant growth deficits by age 5 (Kramer et al.). Researchers determined that plasma zinc may not be a sensitive indicator of limiting deficiency, especially in children with SCD, where sickled hemoglobin may contaminate blood samples. In present study, there were no significant differences in growth related to baseline plasma zinc concentrations. However, zinc supplementation was associated with linear growth and improved nutritional status. It is debated whether this study used appropriate supplement doses to see effects.

18. Strengths/Limitations Study design Body composition assessed by DXA scan Serum zinc levels were tested Small subject number Serum zinc results were not reported throughout the 12 months No dietary control

19. Conclusions Results were insignificant in the present study, however it was determined that children with sickle cell disease may have zinc deficiency and could possibly benefit from zinc supplementation to improve growth and weight gain.

20. References Zemel BS, Kawchak DA, Fung EB, Ohene-Frempong K, Stallings VA. Effect of zinc supplementation on growth and body composition in children with sickle cell disease. Am J Clin Nutr. 2002 Feb;75(2):300-7. Zemel BSKawchak DAFung EBOhene-Frempong KStallings VAAm J Clin Nutr. Sickle Cell Anemia http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001554/ Zinc http://www.mayoclinic.com/health/zinc/NS_patient-zinc Hemoglobin http://en.wikipedia.org/wiki/Hemoglobin#Types_in_humans Gropper S, Smith J, Groff J. Advanced Nutrition and Human Metabolism. 5 th Ed. 2009. 489-491. Carter JP, Grivetti LE, Davis JT, Nasiff S, Mansour A, Mousa WA, Atta AE, Patwardhan VN, Moneim MA, Abdou IA, Darby WJ. Growth and sexual development of adolescent Egyptian village boys. Effects of zinc, iron, and placebo supplementation. Am J Clin Nutr. 1969 January; 22(1): 59–78. Platt OS, Rosenstock W, Espeland M. Influence of Sickle Hemoglobinopathies on Growth and Development. N Engl J Med 1984;311:7-12. Henderson RA, Saavedra JM, Dover GJ. Prevalence of impaired growth in children with homozygous sickle cell anemia. Am J Med Sci 1994;307:405-7. Kramer MS, Rooks Y, Washington LA, Pearson HA, Pre- and post-natal growth and development in sickle cell anemia. J Pediatr 1980;96:857-60