Lipids profile in children and adolescents with β-thalassemia major

Jabbar, Hayder Kadhim; Hassan, Meaad Kadhum; Al-Naama, Lamia Mustafa

doi:10.1016/j.htct.2022.09.1277

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Hematology, Transfusion and Cell Therapy

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Original article • Hematol., Transfus. Cell Ther. 45 (4) • 2023 • https://doi.org/10.1016/j.htct.2022.09.1277 copy

Lipids profile in children and adolescents with β-thalassemia major

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Patients with β-thalassemia major (β-TM) are at risk of developing abnormal lipid profiles. Lipid abnormalities, in turn, have a potential role in the pathogenesis of some clinical aspects of thalassemia

Objectives:

To evaluate lipid levels and atherogenic indices in β-TM patients compared to healthy children and for any association between lipid levels, lipid peroxidation and inflammatory biomarkers

Methods:

This case-control study was carried out on 79 patients with β-TM, aged 6 to 16 years, registered at the Basrah Center for Hereditary Blood Diseases and 85 age- and sex-matched apparently healthy children and adolescents. Complete blood count, serum lipids and ferritin, liver function tests, C-reactive protein (CRP), high-sensitivity CRP (hs-CRP) and serum malondialdehyde (MDA) were evaluated

Results:

Patients with β-TM had significantly lower hemoglobin (Hb), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and non-high-density lipoprotein (non-HDL) and significantly higher very low-density lipoprotein (VLDL), triglycerides (TGs), LDL/HDL ratio, MDA, hs-CRP, total serum bilirubin (TSB), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) than the control group (p < 0.05). A bivariate analysis revealed that TC has a significant positive association with Hb. The TG has a significant negative association with Hb and a positive association with serum ferritin. Furthermore, MDA, TG, TSB, ALT and AST were significantly positively correlated with serum ferritin (p < 0.05)

Conclusions:

Atherogenic dyslipidemia, defined as a high low-density lipoprotein cholesterol (LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio and high TG level, is common among pediatric β-TM patients, it is associated with iron overload and places patients at an increased cardiovascular risk.

Keywords:
Lipid profile; Atherogenic index; B-thalassemia major

Variable		ß-TM patients (Total N. 79) N. (%)
Age (years)	6-10	49 (62.1)
	>10-16	30 (37.9)
Age (years) mean± SE		9.62 ±0.36
Sex	Female	37 46.8
	Male	42 53.2
Jaundice		17 (21.5)
Hepatomegaly		13 (16.5)
Splenomegaly		34 (43)
Splenectomy		45 (56.9)
Blood transfusion	1-2/month	62 (78.5)
	> 2/month	17 (21.5)
Weight (mean± SE)		22.38 ± 0.75
Height (mean± SE)		124.14 ± 1.45
BMI (mean± SE)		16.10 ± 0.26
HCV (PCR)	Positive	18 (22.8)
	Negative	61 (77.2)
S. ferritin (ng/ml)	<1000	2 (2.5)
	1000-2500	15 (19)
	>2500	62 (78.5)
	Mean± SE	4851.75 ± 703.5
Iron chelators	DFX	58 (73.4)
	DFO	16 (20.3)
	Both	5(6.3)

Variable	β-TM patients (N. 79) Mean ± SE	Control group (N. 85) Mean ± SE	P value
Hb (g/dl)	7.16 ± 0.07	11.65 ± 0.11	<0.001
Total WBC (× 10⁹9 Satapathy N, Ghosh N, Archana Y, Dash BP. Hypocholesterolaemia in beta-thalassaemia. Epidemiol. 2012;2:113. https://doi.org/10.4172/2161-1165.1000113. https://doi.org/10.4172/2161-1165.100011... /l)	16.08 ±1.21	7.60 ± 0.15	0.009
Platelets (× 10⁹9 Satapathy N, Ghosh N, Archana Y, Dash BP. Hypocholesterolaemia in beta-thalassaemia. Epidemiol. 2012;2:113. https://doi.org/10.4172/2161-1165.1000113. https://doi.org/10.4172/2161-1165.100011... /l)	417.25 ± 22.18	281.02 ± 5.86	<0.001
TC (mg/dl)	143.35 ± 1.39	184.57 ± 1.09	< 0.001
HDL (mg/dl)	27.51 ±0.58	47.50 ± 0.72	<0.001
LDL (mg/dl)	85.27 ±1.64	112.47 ± 1.11	<0.001
VLDL (mg/dl)	31.90 ± 0.58	24.75 ± 0.13	<0.001
Non-HDL (mg/dl)	115.78 ±1.5	137.22 ± 1.11	<0.001
TG (mg/dl)	163.94 ± 2.41	123.77 ± 0.63	<0.001
AI	3.35 ±0.13	2.41 ± 0.05	0.030
MDA (μmol/l)	1.49 ± 0.16	0.24 ± 0.01	<0.001
CRP (mg/L)	5.32 ± 0.96	5.43 ± 0.61	0.920
hsCRP (mg/L)	7.26 ±1.75	3.25± 0.36	0.026
TSB (μmol/l)	28.58 ± 1.28	8.50 ± 0.29	<0.001
ALT (IU/L)	39.31 ± 1.19	26.26 ± 0.20	<0.001
AST (IU/L)	41.18 ± 2.66	10.47 ± 0.25	<0.001

Parameter	Serum TC (mg/dl)		TG (mg/dl)
Parameter	r^* * Spearman's correlation coefficients.	P value	r^* * Spearman's correlation coefficients.	P value
Age	-0.835	0.407	-0.055	0.632
Sex	-1.400	0.166	0.041	0.719
Wt.	1.874	0.065	0.010	0.931
Ht.	-1.882	0.064	-0.022	0.844
BMI	-0.400	0.165	-0.060	0.600
Hb	0.041	< 0.001	-0.051	0.002
WBC	0.462	0.671	-0.214	0.058
Platelet	1.079	0.285	0.004	0.973
MDA	0.867	0.389	-0.161	0.156
S. ferritin	-0.466	0.643	0.078	0.031
CRP	-0.026	0.979	0.039	0.734
hsCRP	-0.060	0.952	-0.023	0.846

Parameter	Serum Ferritin (ng/ml)		Hemoglobin (g/dl)
Parameter	r^* * Spearman's correlation coefficients.	P value	r^* * Spearman's correlation coefficients.	P value
MDA	0.129	0.025	-0.067	0.555
TC	1.052	0.663	0.041	< 0.001
HDL	-0.026	0.819	0.080	0.483
LDL	0.051	0.655	-0.208	0.065
VLDL	-0.052	0.655	0.256	0.023
Non-HDL	0.061	0.594	-0.012	0.920
TG	0.002	0.031	-0.051	0.002
TSB	0.064	0.025	-0.109	0.339
ALT	0.189	0.030	-0.025	0.825
AST	0.060	0.021	0.113	0.322
CRP	-0.002	0.985	0.048	0.671
hsCRP	-0.074	0.681	0.137	0.229

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

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[1] *Corresponding author at: Department of Pediatrics, College of Medicine, University of Basrah, Basrah, Iraq. E-mail address: meaad.hassan@uobasrah.edu.iq (M.K. Hassan).