Adequacy of Dietary Intake Declines with Age in Children with Sickle Cell Disease

Abstract

Dietary intake (24-hour recall) was evaluated prospectively over four annual visits in 97 children and adolescents (53 female), aged 1.5 to 18.7 years, with sickle cell disease, type SS. Macro- and micronutrient intakes were compared to Dietary Reference Intakes (DRI) and expressed as %DRI. z scores for height, weight, and body mass index were calculated to assess growth status. Both t tests and Mann-Whitney U tests were used for year 1 comparisons, and longitudinal mixed effects analysis was used for the longitudinal data. Intake of vitamins E and D, folate, calcium, and fiber as %DRI was low for children of all ages. Intake of protein, vitamin C, riboflavin, vitamin B-12, and magnesium was lower by at least 28% DRI in the oldest (aged 14 to 18 years) compared to the youngest children (aged 1 to 3 years), and intake of vitamin A, magnesium, and phosphorus was suboptimal in children older than 9 years. After adjusting for initial age and sex, intake of riboflavin, zinc, calcium, magnesium, and phosphorus declined steeply (8% to 16% DRI annually) across the 3 years. Weight and body mass index z scores also declined over time. Dietary intake was particularly poor in adolescents. Efforts are needed to ensure dietary adequacy in children with sickle cell disease, type SS and to understand the etiology of poor dietary intake.