Nutritional Status in a Sample of Patients With β-Thalassemia Major

Abstract

Background: Patients suffering from thalassemia have decreased levels of lean body mass and an increased nutritional risk. To assess the body composition and vitamin D levels of thalassemic patients in relation to nutritional risk.Methods: A total of 67 consecutive adult patients who were diagnosed with thalassemia major and followed a regular blood transfusion scheme were included in this study. Demographic and clinical data were collected for each participant. Blood samples were collected to assess 25-hydroxy-vitamin D (25-OH-D) levels. The assessment of patients' nutritional risk was based on the Malnutrition Universal Screening Tool. Body composition assessment was based on bioelectrical impedance analysis (BIA).Results: Eleven patients (16.4%) and five patients (7.5%) were at moderate and high risk for malnutrition, respectively. Moreover, 86.6% of patients had a low fat-free mass index (FFMI) and 74.6% of patients had a high-fat mass (FM) index. The prevalence of sarcopenic obesity and 25-OH-D deficiency was 64.2% and 92.2%, respectively. Medium and high-risk patients had significantly lower BMI (18.81 ± 1.29 vs 23.90 ± 2.65 kg/m 2 , p<0.001), lower FFM index (12.80 ± 1.38 vs 14.19 ± 1.89 kg/m 2 , p=0.009) and lower FM index (5.97 ± 1.86 vs 9.70 ± 2.70 kg/m 2 , p<0.001) than their low-risk counterparts.Conclusions: Adult patients with β-thalassemia major had low levels of vitamin D and altered body composition, presenting with increased adiposity, low levels of lean body mass, and high rates of sarcopenic obesity. Timely detection of patients at risk could lead to the prioritization of patients who could benefit from nutritional interventions.

Liver steatosis in patients with transfusion‐dependent thalassaemia

“…In fact, in the case of TDT patients, chronic anaemia is responsible for sedentary and low physical activity patterns and exercise levels, 50,51 which in turn lead to low muscle mass, deranged body composition with central obesity and visceral fat 52 . As a consequence, the increased BMI observed in our population with LS could be suggestive of obesity, one of the leading components of metabolic syndrome 49,53 . Regarding the metabolic profile, it is a quite old observation that patients with thalassaemia have both reduced total cholesterol and low‐density lipoprotein levels 54 .…”

“…52 As a consequence, the increased BMI observed in our population with LS could be suggestive of obesity, one of the leading components of metabolic syndrome. 49,53 Regarding the metabolic profile, it is a quite old observation that patients with thalassaemia have both reduced total cholesterol and low-density lipoprotein levels. 54 On the other hand, a regular transfusion regimen, despite essential for good quality of life, is responsible for iron overload and, in the past, for HCV infection.…”

Liver disease in patients with transfusion-dependent β-thalassemia: The emerging role of metabolism dysfunction-associated steatotic liver disease

“…One possible explanation for this phenomenon is that BMI values within normal range does not exclude for this group of patients an unbalanced body composition with central obesity and visceral fat. In fact, it may occur especially in patients with thalassemia, where reduced stamina due to anemia, results in reduced physical activity levels and subsequently in low muscle mass[ 54 ].…”

Liver fibrosis in young patients with transfusion‐dependent thalassaemia (TDT), understanding the role of steatosis

“…The authors correctly argued that it likely happened because normal BMI in this category of patients may not exclude an unbalanced body composition with central obesity and visceral fat. In fact, it may occur in patients with thalassaemia, where reduced physical activity levels due to anaemia could be responsible of low muscle mass and a low fat-free mass index, as very recently highlighted by a study from Lidoriki et al 8 However, the study of Padeniya et al 7 seems to suggest that we should search for steatosis very early in patients with thalassaemia and raises questions about the optimal diagnostic tool for measuring steatosis in clinical practice. In fact, transient elastography allows the simultaneous assessment of liver fibrosis and steatosis but is not a universally available methodology; on the other hand, the assessment of the presence of fat in the liver could be performed during the radiological evaluation of liver iron overload, but the authors correctly pointed out that fat estimation by magnetic resonance imaging is reliable only when the LIC is >7 mg Fe/g dry tissue.…”

“…The authors correctly argued that it likely happened because normal BMI in this category of patients may not exclude an unbalanced body composition with central obesity and visceral fat. In fact, it may occur in patients with thalassaemia, where reduced physical activity levels due to anaemia could be responsible of low muscle mass and a low fat‐free mass index, as very recently highlighted by a study from Lidoriki et al 8 …”