ABSTRACT
Impaired growth involving both height and weight accompanying thalassemia major poses diagnostic and therapeutic problems. We undertook this study to test the hypothesis that this impaired growth might be corrected, partially or totally, by increasing caloric intake of these patients to compensate for their hypermetabolic status accompanying their anemia and bone marrow hyperactivity. Thirty randomly selected children with thalassemia major were studied. The dietary intake of the thalassemic patients, evaluated by the recall method, appeared to be adequate compared to 30 normal age-matched children. Nutritional status was assessed by measuring the weight, body mass index [BMI], mid-arm circumference [MAC], triceps skin fold thickness [SFT] and serum albumin and insulin-like growth factor-I [IGF-I] concentrations of before and after 8 weeks of high-caloric diet [130-150% of the caloric recommendation for age and sex]. The BMI, triceps SFT and MAC of children with thalassemia were significantly decreased compared to those for the normal control group. IGF-I and albumin concentrations of thalassemic children [69 +/- 20.5 ng/m and 3.65 +/- 0.67 g/dl respectively] were significantly lower than those for normal age-matched children [162.5 +/- 24 ng/ml and 4.29 +/- 0.66 g/dl respectively]. After nutritional supplementation for 8 weeks the MAC, SFT and BMI of the thalassemic children increased significantly [p < 0.05]. Serum IGF-I [84.3 +/- 27.3 ng/ml] and albumin concentrations [3.85 +/- 0.85 g/dl] increased significantly in the thalassemic group after versus before nutritional supplementation however, they were still lower than those for normal children. It appears that the hypermetabolic status of children with thalassemia contributes to their decreased IGFúI synthesis in these patients with subsequent slowing of linear growth and weight gain. Increased caloric dietary intake increased significantly IGF-I synthesis in these patients. This was accompanied with increased BMI, mid-arm circumference and skin fold thickness. Growth impairment of children with thalassemia major, without endocrinopathy and/or cardiomyopathy, can be partially correctable by increasing caloric intake to compensate for their hypermetabolic status