Proper Nutrition Lacking in Children with Hemophilia in Iraqi Province, Study Says

Proper nutrition is lacking in almost half of children with hemophilia in Iraq, with a significant portion of these children underweight compared to peers and a sizable number overweight, a study of pediatric patients in an Iraqi province found.

The work also showed an association between low levels of parental education and excessive weight or obesity in adolescents with hemophilia, supporting the importance of information and the ability to apply it well in managing hemophilia and body weight.

The study, “Nutritional status of children and adolescents with haemophilia in Basra, Iraq,” was published in the journal Haemophilia.

Long-term survival of hemophilia patients, associated with the development of effective therapies, makes them more susceptible to common chronic diseases, including obesity.

Moreover, “children with hemophilia may be at an increased risk of becoming overweight as a result of inactivity due to joint bleeding or overprotection,” the researchers wrote.

However, increasing evidence suggests that widespread access to prophylactic (preventive) therapy can lessen differences in both nutritional status and physical activity between children with hemophilia and their healthy peers.

Iraqi researchers evaluated the nutritional status and physical activity of pediatric hemophilia patients in Basra, in southern Iraq, to identify potential risk factors of nutritional problems in these children.

The study included 63 children and teenagers (ages 5 to 18) with hemophilia A and B, registered at the Basra Centre for Hereditary Blood Diseases, and 135 healthy age-matched children from across Basra province serving as controls.

They analyzed participants’ socioeconomic and clinical data, as well as their nutritional status using body mass index z-scores (BMIZ), which measure a child’s relative weight adjusted for age and gender.

Physical activity was assessed through the Children’s Physical Activity Questionnaire (CPAQ) for those younger than 15 years old, and the Arabic version of the International Physical Activity Questionnaire (IPAQ) for those 15 to 18.

Children’s mean age was about 11 years old, and 13 (20.6%) of those with hemophilia and 16 (11.9%) of controls were of preschool age. More than half (57.1%) of the patients were on prophylactic treatment (or prophylaxis), as were 10 out of 12 (83.3%) with severe hemophilia.

Results showed that around 43% of hemophiliacs were classified as having a nutritional problem (on both ends of the weight spectrum), according to the BMIZ data.

Notably, a significantly higher proportion of hemophilia patients were thin or severely thin (19.1%) compared with their healthy peers (9.6%), while an opposite trend was found for excessive weight and obesity between these two groups (23.8% of patients and 36.3% of controls).

Paternal educational level and family income was significantly lower in the hemophilia group than in the healthy group, which could influence the children’s daily diet.

The higher frequency of thinness in these young hemophilia patients was consistent with a previous Iranian study showing that “adult patients with hemophilia had low weight and low BMI compared with the normal population,” the researchers wrote.

Significant differences were also found in terms of physical activity between younger children (ages 5 to 14), with significantly more children with hemophilia being less active (22.7%) than healthy children (2.1%). Levels of physical activity were similar among older adolescents of either group.

Patients’ nutritional status did not significantly change with age, hemophilia type, disease severity, prophylaxis status, or level of physical activity. However, a significant association was seen between low levels of paternal educational and overweight or obesity in teenagers 15 to 18 years old.

“Paternal education can increase the ability of parents to gain and process information, and a higher education level may also provide access to more skilled work and thus a higher income, which can be reflected in health,” the researchers wrote.

They noted that larger studies, involving more participants in both groups, are required to confirm these results, especially “taking into consideration the high frequency of nutritional problems in our province.”