Macronutrient and micronutrient requirements in sickle cell disease across age groups: a narrative review.

BACKGROUND

Sickle cell disease (SCD) is a hereditary haemoglobinopathy characterised by chronic haemolysis, inflammation, oxidative stress, and increased metabolic demands. Nutritional deficiencies worsen disease severity, growth, immunity, and quality of life, but evidence on age‑specific needs is fragmented. This narrative review synthesises current evidence on macronutrient and micronutrient requirements, deficiencies, and interventions in SCD across age groups.

METHODS

A structured literature search was conducted in PubMed, Scopus, and Google Scholar (January 2000-March 2025). Original studies evaluating nutritional status or interventions in confirmed SCD were included.

RESULTS

Individuals with SCD are in a hypermetabolic state with elevated energy and protein requirements. Common micronutrient deficiencies include vitamin D (prevalence 56.2% in children, 75.5% in adults), zinc, vitamin B12, folate, and vitamin C. Zinc deficiency is associated with more vaso‑occlusive crises, infections, delayed growth, and hospitalisations. Omega‑3 fatty acids, L‑arginine, glutamine, zinc, and vitamin D supplementation show potential benefits in reducing pain severity, vaso‑occlusive events, inflammation, and hospital admissions, while improving growth, endothelial function, and quality of life. However, the certainty of the evidence is low to very low due to small sample sizes and heterogeneous methods; adult‑specific data are particularly scarce.

CONCLUSION

Major gaps remain in standardised dietary recommendations and supplementation protocols. Large, high‑quality randomised controlled trials are urgently needed to establish evidence‑based nutritional guidelines for SCD.