Background: There is conflicting data on the effects of sickle cell disease (SCD) on anthropometrics. While some studies report that SCD impacts anthropometrics, others do not. Further, anthropometrics can also impact clinical outcomes. Growth impairment early in life can delay later developmental milestones, including pubertal onset. Growth failure has been shown to be associated with more severe sickle cell genotypes, endocrine dysfunction, and lower hemoglobin. Supporting nutritional status to improve anthropometric measures during early childhood has been associated with improved clinical outcomes in other genetic disorders, such as cystic fibrosis. Data on the effects of early life anthropometrics on anthropometrics in older children with SCD is limited.

Aim: To determine if anthropometrics (weight, height, and weight for length (WFL)) early in life predict anthropometrics later on in life in the same children with SCD.

Methods: We conducted an IRB-approved retrospective study at a single institution for all children with SCD 0-19 years who attended the SCD clinic over a 5-year period (2018-2023). We collected anthropometric measures for all participants during their visits to SCD clinic using the same measurement protocols, when they were at their baseline steady state without SCD-related exacerbations. Descriptive statistics were used to compare baseline characteristics. Paired anthropometrics (weight, height, weight for length (WFL) for < 2 years and body mass index (BMI) ≥ 2 years) at early life (0-2 years) and later life (3-6 years and 3-12 years) based on z-scores and percentiles were compared using Pearson correlation coefficient to examine their linear association. A general linear regression model was fitted to investigate the ability of anthropometrics in early life to predict the values in later life. A model adjusting for sex and SCD genotype (mild; HbSC and HbSBeta Thal+ versus severe; HbSS and HbSBeta Thal0) and another model adding interaction between genotype and early life measurements were fitted to investigate if the predictive ability of early life measurements changes due to these adjustments. Average age z-scores and percentile scores for all participants were compared to the general population using the WHO and CDC charts. R software (version 4.5) was used for analysis.

Results: A total of 1,176 participant anthropometrics were used to create growth charts for children with SCD, as well as for comparison with the WHO and CDC growth charts. Participants were mostly African Americans (98%), males (52%) with mostly HbSS genotype (54%). Ninety-four participants had at least one anthropometric data corresponding to each of the 2 time points (0-2, and 3-6 or 3-12 years). We found that for all anthropometrics, early in life (0-2 years) measurements correlated significantly with measurements at later time points (3-6 years and 3-12 years) for the same individuals. Anthropometrics at 0-2 years vs. 3-6 years positively correlated for height z score (r=0.73, 95% CI [0.62, 0.82]; p < 0.001), weight z score (r=0.75, 95% CI [0.65, 0.83]; p<0.001), and BMI/ WFL z score (r=0.69, 95% CI [0.57, 0.79]; p<0.001). Positive correlations were also significant between 0-2 years vs. 3-12 years in height z score (r=0.73, 95% CI [0.62, 0.81]; p < 0.001), weight z score (r=0.75, 95% CI [0.64, 0.82]; p<0.001), and BMI/ WFL z score (r=0.69, 95% CI [0.57, 0.79]; p<0.001. The correlation was significantly higher for height z score for children with severe genotypes (p<0.05) compared to the milder genotypes, and children with severe genotypes were shorter than those with mild genotypes (p<0.05). Weight z scores at 0-2 years significantly differed by sex, with males having lower weight z scores than females (p<0.05). Anthropometric measurements differed between children with SCD and healthy children. Children with SCD were shorter than their peers.

Conclusion: In children with SCD, anthropometrics early in life (0-2 years) predict measurements at later years in the same individuals. Growth parameters in children with SCD at our center are significantly different from those of healthy individuals. Further, children with SCD with severe genotypes are shorter than those with mild genotypes. Males with SCD have lower weight z scores compared to females with SCD. Given studies linking anthropometrics to clinical outcomes, it is critical to optimize early growth in children with SCD to improve clinical outcomes.

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2025
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