Nutritional Perspectives On Sickle Cell Disease In Africa: A Systematic Review

Abstract Background Sickle Cell Disease (SCD) is an inherited blood disorder and mostly affects individuals living in sub-Saharan Africa. Whilst there is an established link between its pathophysiology and nutritional status, research in this area in Africa is limited and evidence-based nutritional guidelines lacking. This systematic review aimed to evaluate studies in sub-Saharan Africa focused on nutritional aspects of SCD, codify results, and highlight 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. We sought to include all studies involving original research of nutritional status of individuals (children and adults) with SCD in Africa. ‘Nutritional status’ was defined as topics related to dietary intake, measurements of growth or anthropometry, and nutritional-related biomarkers. Studies of anemia alone in non-SCD individuals were excluded as well as studies that assessed individuals with sickle cell trait (i.e., carriers). The databases used were Ovid Embase, Medline, Biosis and Web of Science. Studies conducted between 1995 and 2018 were included in the analyses. Results The search returned 366 articles from which 66 studies were included in the final analyses. Most investigations (70%) were conducted in Nigeria. Studies were categorized into one of three main categories: descriptive studies of anthropometric characteristics (47% of studies), descriptive studies of macro- or micronutrient levels (36% of studies), and interventional studies (14% of studies). There were fairly uniform findings that demonstrate that the growth of SCD patients in sub-Saharan Africa was impaired, especially in childhood and adolescence. Studies assessing macro- and micro-nutrients generally had small sample sizes and were exploratory in nature. Only two randomized, placebo-controlled trials were identified, which measured the impact of fatty acid supplementation and lime juice on health outcomes. Conclusions The findings of this review are consistent with data from other regional settings that describe a significant risk of malnutrition in individuals with SCD. There appears to be a substantial unmet need for clinical research to better understand the potential utility of nutritional-related interventions for patients with SCD in sub-Saharan Africa, to promote optimal growth and improve health outcomes.