Nartey Eunice Berko, Spector Jonathan, Adu-Afarwuah Seth, Jones Catherine L, Jackson Alan, Ohemeng Agartha, Shah Rajiv, Koryo-Dabrah Alice, Kuma Amma Benneh-Akwasi, Hyacinth Hyacinth I, Steiner-Asiedu Matilda
Department of Nutrition and Food Science, University of Ghana, Legon, Ghana.
Department of Nutrition and Dietetics, University of Health and Allied Sciences, PMB 31, Ho, V/R, Ghana.
BMC Nutr. 2021 Mar 18;7(1):9. doi: 10.1186/s40795-021-00410-w.
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.
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.
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, long-chain fatty acids supplementation, ready-to-use supplementary food (RUSF), and oral arginine on health outcomes.
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.
镰状细胞病（SCD）是一种遗传性血液疾病，主要影响撒哈拉以南非洲地区的人群。然而，目前缺乏阐明非洲患者SCD病理生理学与营养状况之间联系的研究。本系统评价旨在评估撒哈拉以南非洲地区聚焦于SCD营养方面的研究情况，并突出知识空白，为未来研究的优先事项设定提供参考。
本研究按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。纳入标准包括1995年1月至2020年11月期间发表的、经同行评审的原创研究，研究对象为非洲患有任何SCD表型变异的个体，且至少有一项营养状况结果。营养状况结果定义为评估饮食摄入量、生长/人体测量学或营养生物标志物的结果。使用的数据库有Ovid Embase、Medline、Biosis和科学网。
检索共返回526篇文章，其中76篇纳入最终分析。大多数研究（67%）在尼日利亚进行。研究分为三大类之一：人体测量学特征的描述性研究（49%）、常量或微量营养素状况的描述性研究（41%）以及干预性研究（11%）。研究结果一致显示存在生长发育障碍，尤其是撒哈拉以南非洲地区的儿童和青少年。评估常量和微量营养素的研究通常样本量较小，且具有探索性质。仅确定了四项随机试验，这些试验测量了柠檬汁、补充长链脂肪酸、即食补充食品（RUSF）和口服精氨酸对健康结果的影响。
研究结果显示有一定数量的描述性研究，多数样本量较小，聚焦于非洲患者营养和SCD的各个方面。严重缺乏可用于为临床实践中基于证据的改变提供依据的数据的干预性研究。调查结果总体上与其他地区的数据一致，表明SCD患者存在生长发育迟缓和营养不良的重大风险。迫切需要开展临床研究，以更好地了解营养相关干预措施对撒哈拉以南非洲地区SCD患者的潜在益处，从而促进最佳生长并改善健康结果。
