Fahmida Hashem :
Thalassemia is a group of inherited blood disorders that affect the body’s ability to produce hemoglobin and red blood cells. This is one of the most common single gene disorders in humans. Abnormal growth is a common feature of thalassaemia major in children.
World Health Organization (WHO) estimates that at least 6.5 per cent of the world populations are carries of different inherited disorders of hemoglobin.
Another WHO report estimates that 3 per cent are carriers of beta-thalassemia and 4 per cent are carriers of Hb E in Bangladesh. In Bangladesh, more than 7000 children are born with thalassemia each year and nearly 40 per cent of bloods in our blood-banks are used for Thalassemic patients.
Patients with thalassemia commonly exhibit inadequate growth, poor immune function, increased oxidative stress and decreased bone mineralisation all morbidities with linkages to poor nutritional status.
Thalassemia may be treated with life-sustaining blood transfusions. Regular blood transfusions can lead to iron overload in the body. Extra iron from chronic transfusions is stored in the liver. Once the liver stores are full, the iron begins to accumulate in places like the heart and pituitary, where it can do damage.
Iron overload can be successfully managed with chelation therapy to remove excess iron from the body. Non-transfused patients are encouraged to consume a moderately low-iron diet-that is, avoiding iron-fortified foods and excessive consumption of red meat. Do not cook with cast iron cookware because iron from the cookware can transfer onto the food.
Very high iron and protein sources like liver, beans, beef, peanut butter, Grains like infant cereal and cornflakes, Fruits/Vegetables like orange juice, watermelon, spinach, leafy green vegetables, dates, raisins, broccoli, peas should be eliminated from thalassemic children’s diet. It is not, however, a good idea to exclude meat, chicken and fish completely from your diet because they contain other important nutrients, particularly for children. Choose the white part of chicken rather than red meat as it contains less iron.
It is a treatable disorder that can be well-managed with blood transfusions and chelation therapy. But the truth is, there are actually no specific food diet for Thalassemia .
When iron is avoided in the diet, zinc intake is frequently reduced which is an essential nutrient that has been shown to be particularly beneficial to immune status, bone health, and growth in thalassemia. Several studies have shown that people with thalassaemia tend to have low levels of zinc in the blood, probably because they excrete more zinc in the urine.
They have reduced intake of many key nutrients (vitamin A, D, E, K, folate, calcium and magnesium).
Optimising dietary intake through nutrient dense foods and appropriate use of supplementation where necessary may improve overall health in these children.
Thalassemic children care in Bangladesh is very poor. Ninety percent of children’s family cannot afford adequate treatment. Majority of the patients cannot afford to buy the drugs. The government should pay attention for prevention, care and management of thalassaemic patients. Every major hospital should have a thalassaemia center. The drugs should be subsidised. Carrier screening and prevention of births of thalassaemic children should be now a priority as it has been established that prevention of births of thalassaemic children. DNA lab must immediately be established in this regard.
Two carriers of the disease should not marry. This will prevent transmission of the disease. Carrier-detection tests should be made generally available.
Public awareness about this must be built up through advocacy. Affected families should get all their children examined, and also before marriage, the prospective couples should take the requisite blood tests.
Thalassemic children need to be recognized, as an important health issue in Bangladesh and steps need to be taken to control the birth of thalassemic children. Creating awareness, Population screening and Genetic counseling to be recommended and which are being followed in many countries. Both government and non-government efforts are urgently required now for prevention and containment of this dread disease.
Let us all pledge to eliminate this silent killer of children through our combined efforts and undertake an appropriate programme for our future generations.
This is best for parents to meet with a nutritionist at their center if they have the opportunity to do so first. Take advantage of your nutritionist/dietitian; they are a fabulous resource. They will assess your child’s diet and give you specific nutritional feedback as to what would be most helpful for him/her. If you are particularly concerned about your child’s intake and he/she is not eating a varied diet (picky/food intolerances/etc) a chewable multivitamin without iron is your best bet. So, thalassemic children should be evaluated annually by a nutritionist regarding adequate dietary intake. n
[Fahmida Hashem is Consulting Nutritionist & CEO, Miss Nutritionist (Center for Nutrition & Weight Management]
Thalassemia is a group of inherited blood disorders that affect the body’s ability to produce hemoglobin and red blood cells. This is one of the most common single gene disorders in humans. Abnormal growth is a common feature of thalassaemia major in children.
World Health Organization (WHO) estimates that at least 6.5 per cent of the world populations are carries of different inherited disorders of hemoglobin.
Another WHO report estimates that 3 per cent are carriers of beta-thalassemia and 4 per cent are carriers of Hb E in Bangladesh. In Bangladesh, more than 7000 children are born with thalassemia each year and nearly 40 per cent of bloods in our blood-banks are used for Thalassemic patients.
Patients with thalassemia commonly exhibit inadequate growth, poor immune function, increased oxidative stress and decreased bone mineralisation all morbidities with linkages to poor nutritional status.
Thalassemia may be treated with life-sustaining blood transfusions. Regular blood transfusions can lead to iron overload in the body. Extra iron from chronic transfusions is stored in the liver. Once the liver stores are full, the iron begins to accumulate in places like the heart and pituitary, where it can do damage.
Iron overload can be successfully managed with chelation therapy to remove excess iron from the body. Non-transfused patients are encouraged to consume a moderately low-iron diet-that is, avoiding iron-fortified foods and excessive consumption of red meat. Do not cook with cast iron cookware because iron from the cookware can transfer onto the food.
Very high iron and protein sources like liver, beans, beef, peanut butter, Grains like infant cereal and cornflakes, Fruits/Vegetables like orange juice, watermelon, spinach, leafy green vegetables, dates, raisins, broccoli, peas should be eliminated from thalassemic children’s diet. It is not, however, a good idea to exclude meat, chicken and fish completely from your diet because they contain other important nutrients, particularly for children. Choose the white part of chicken rather than red meat as it contains less iron.
It is a treatable disorder that can be well-managed with blood transfusions and chelation therapy. But the truth is, there are actually no specific food diet for Thalassemia .
When iron is avoided in the diet, zinc intake is frequently reduced which is an essential nutrient that has been shown to be particularly beneficial to immune status, bone health, and growth in thalassemia. Several studies have shown that people with thalassaemia tend to have low levels of zinc in the blood, probably because they excrete more zinc in the urine.
They have reduced intake of many key nutrients (vitamin A, D, E, K, folate, calcium and magnesium).
Optimising dietary intake through nutrient dense foods and appropriate use of supplementation where necessary may improve overall health in these children.
Thalassemic children care in Bangladesh is very poor. Ninety percent of children’s family cannot afford adequate treatment. Majority of the patients cannot afford to buy the drugs. The government should pay attention for prevention, care and management of thalassaemic patients. Every major hospital should have a thalassaemia center. The drugs should be subsidised. Carrier screening and prevention of births of thalassaemic children should be now a priority as it has been established that prevention of births of thalassaemic children. DNA lab must immediately be established in this regard.
Two carriers of the disease should not marry. This will prevent transmission of the disease. Carrier-detection tests should be made generally available.
Public awareness about this must be built up through advocacy. Affected families should get all their children examined, and also before marriage, the prospective couples should take the requisite blood tests.
Thalassemic children need to be recognized, as an important health issue in Bangladesh and steps need to be taken to control the birth of thalassemic children. Creating awareness, Population screening and Genetic counseling to be recommended and which are being followed in many countries. Both government and non-government efforts are urgently required now for prevention and containment of this dread disease.
Let us all pledge to eliminate this silent killer of children through our combined efforts and undertake an appropriate programme for our future generations.
This is best for parents to meet with a nutritionist at their center if they have the opportunity to do so first. Take advantage of your nutritionist/dietitian; they are a fabulous resource. They will assess your child’s diet and give you specific nutritional feedback as to what would be most helpful for him/her. If you are particularly concerned about your child’s intake and he/she is not eating a varied diet (picky/food intolerances/etc) a chewable multivitamin without iron is your best bet. So, thalassemic children should be evaluated annually by a nutritionist regarding adequate dietary intake. n
[Fahmida Hashem is Consulting Nutritionist & CEO, Miss Nutritionist (Center for Nutrition & Weight Management]
