Relationship between Chronic Transfusion Therapy and Body Composition in Subjects with Thalassemia

• Published in: The Journal of pediatrics 2010-10, Vol.157 (4), p.641-647.e2
• Main Authors: Fung, Ellen B., PhD, RD, Xu, Yan, MS, Kwiatkowski, Janet L., MD, MSCE, Vogiatzi, Maria G., MD, Neufeld, Ellis, MD, PhD, Olivieri, Nancy, MD, Vichinsky, Elliott P., MD, Giardina, Patricia J., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Anemias. Hemoglobinopathies; Biological and medical sciences; Blood Transfusion - statistics & numerical data; Body Composition; Body Height; Bone Density; Calcium, Dietary - therapeutic use; Child; Comorbidity; Cross-Sectional Studies; Diseases of red blood cells; Female; General aspects; Health Status; Hematologic and hematopoietic diseases; Humans; Hypogonadism - epidemiology; Iron - metabolism; Male; Medical sciences; Middle Aged; Pediatrics; Sex Factors; Thalassemia - epidemiology; Thalassemia - metabolism; Time Factors; Vitamin D - therapeutic use; Young Adult
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2010.04.064

Objective To measure body composition in patients with thalassemia and explore its relationship to abnormal growth and bone mass. Study design We conducted a cross-sectional, multicenter study. Fat, lean, and bone mineral density (BMD) were assessed with dual-energy x-ray absorptiometry. Medical history, food frequency, and physical activity questionnaires were conducted in 257 transfused patients with thalassemia (age, 23.7 ± 11 years [mean ± SD]; 51% male) compared with 113 non-transfused patients (21.3 ± 13 years; 44% male). Results Subjects with thalassemia were leaner compared with healthy American subjects from National Health and Nutrition Examination Survey III data. Transfused subjects had a higher percentage of body fat compared with non-transfused subjects after controlling for age, sex, and ethnicity; 11.8% of non-transfused pediatric subjects were considered underweight, significantly lower than National Health and Nutrition Examination Survey data ( P = .03). Hemoglobin level was positively related to lean mass ( P = .008). Body fat and lean mass were positive predictors for both height and BMD z -scores after adjustment for transfusion status, age, sex, ethnicity, calcium intake, and physical activity (all P < .001). Conclusion Although most adult patients with thalassemia had healthy body composition with rare obesity, young non-transfused patients appear at risk for being underweight. Optimizing physical activity and appropriate use of transfusion therapy may improve growth and bone health in these patients who are at-risk for being underweight.