Dietary Effects of Nitrates and Nitrites on Illness Severity by djh75337

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									 Dietary Effects of Nitrates and
 Nitrites on Illness Severity in
Children with Sickle Cell Disease
   Ramsay A. Singer, BA, MBBS1, Diana Cardona-Grau, BA2,
        Deidre Dexter, RD3, and Philippa Sprinz, MD4
                 1Royal    Free Hospital, London, United Kingdom
    2Boston Unversity School of Medicine/Boston Medical Center, Boston, MA

             3 Nutritional Services, Boston Medical Center, Boston, MA

     4Division of Pediatric Hematology/Oncology, Boston University School of

                    Medicine/Boston Medical Center, Boston, MA
                    M di i /B t M di l C t B t
           BACKGROUND
• Sickle cell anemia is an autosomally
  inherited disease in which mutations in the
  two genes for hemoglobin encode (most
  commonly) for a substitution of Val or Lys
  for Glu in the 6th AA of beta globin chain
                           beta-globin
  producing HbSS or the HbSC variant.
               CONT’D
    BACKGROUND CONT D
• Under stress HbS polymerizes and forms
  rigid rods which causes sickling of the red
                                vaso occlusive
  blood cells and can lead to vaso-occlusive
  episodes.
                                vasodilator,
• Nitric oxide (NO) acts as a vasodilator is
  an anti-oxidant and anti-inflammatory, and
  contributes to the inhibition of platelet
  aggregation.
           OBJECTIVE

• This study sought to investigate
  whether a diet high in nitrates or
  nitrites ameliorated sickle cell
  disease severity in patients ages
  2-21.
  2 21
               METHODS
  Forty four           patients,
• Forty-four pediatric patients with the help of
  their parents, completed a 94-question
  modified version of the National Institutes of
  Health 12 month food frequency
  questionnaire.
• 23 foods included in the questionnaire were
  determined to be high in nitrates and nitrites
  and were used in this analysis.
               (CONT’D)
       METHODS (CONT D)
• The analysis compared the values of nitrate
  and nitrite intake, in mg/kg/yr, with the
  patient’s sickle cell disease severity index
  patient s
  score, using the validated tool from
  Sebastiani et al.
• Pearson’s Product Moment Correlation was
                       analysis
  used for statistical analysis.
                 RESULTS

Correlation                        R Score
Yearly intake of nitrates versus   -0.22
severity index score

Yearly intake of nitrites versus   -0.23
severity index score
                                 Yearly intake of nitrates versus severity index score

                        1
   erity Index Score




                       0.8
             x




                       06
                       0.6
                       0.4
                       02
                       0.2
Seve




                        0
                             0    500    1000    1500    2000    2500    3000     3500   4000   4500
                                                Total Nitrate Intake (mg/kg/yr)
                                 Yearly intake of nitrites versus severity index score

                        1
   erity Index Score




                       0.8
             x




                       06
                       0.6

                       0.4
                       0.2
                       02
Seve




                        0
                             0         5          10           15           20      25   30
                                                 Total Nitrite Intake (mg/kg/yr)
               RESULTS
• Sickle cell severity scores ranged from
  0.02 to 0.9 with a median score of 0.16
  Nitrate i t k      df    8 12    /k / t
• Nit t intake ranged from 8.12 mg/kg/yr to
  4085 mg/kg/yr with a median value of
          /k /
  560 mg/kg/yr.
• Nitrite intake ranged from .108 mg/kg/yr to
                    g              g gy
  24.31 mg/kg/yr with a median value of
  8.21 mg/kg/yr.
           g gy
             LIMITATIONS
• Small sample size.
• Accuracy of patients’ and parents’ dietary
  recall.
• Lack of knowledge of exact nitrate and
  nitrite content of foods considered to be rich
  in these nutrients.
• A single unified source for the known nitrate
         g
  and nitrite content in analyzed foods was
  not available.
           CONCLUSIONS

• A negative correlation was found between
  increased consumption of nitrates and
  i         d          ti     f it t      d
  nitrites and sickle cell severity index score.
      FUTURE DIRECTIONS
• Enrollment of more subjects to improve the
  statistical power of this study.
  Design
• D i an i t           ti   l t d ith
               interventional study with
  nitrate/nitrite supplemented diets to further
  analyze the benefit of these nutrients in
  sickle cell disease.

								
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