Socioeconomic Factors and Dietary Patterns in Adults with Sickle Cell Disease
Authors: Ally Syeda Akila , Han Jin , Molokie Robert , Ruiz Maria A , Gordeuk Victor R , Lash James P , Saraf Santosh L 
Published: June 2024

Abstract

Presentation Date: 6/9/2024
Presentation Start Time: 4:15:00 PM

Background
Sickle cell disease (SCD) is characterized by a myriad of acute and chronic complications. These complications negatively impact the ability to achieve educational and occupational goals, making this group a particularly vulnerable population to socioeconomic challenges (PMID 30540112). In the general population, indices of socioeconomic distress are associated with poor nutrition (PMID 25573510), and food insecurity is associated with high dietary fat and low dietary fruit and vegetable intake (PMID 33421089, 25091796, 24944059). The association of individual and community-level socioeconomic distress with dietary patterns in adults with SCD is unclear but could represent a modifiable risk factor for improving health and reducing SCD-related complications.

Methods
We prospectively surveyed adults with SCD to investigate the association between individual and community-level socioeconomic distress with dietary fat and fruit and vegetable intake. Between 7/2022 and 10/2023, we enrolled 100 adults with SCD during an outpatient clinic visit. We assessed fat intake using the National Cancer Institute’s Quick Food Scan and fruit and vegetable intake using the National Cancer Institute’s All Day Screener. Markers of socioeconomic distress were measured using a modified short quantitative survey created by adapting the Centers for Disease Control’s Behavioral Risk Factor Surveillance System Questionnaire. Patients were permitted to skip any questions they did not feel comfortable answering. The distressed community index (DCI), a composite indicator that estimates the economic well-being of a community, was determined for each patient’s residential address. The data were analyzed using descriptive statistics, and the association of indices of individual socioeconomic distress was determined using linear regression adjusting for age and sex.

Results
The median age of the cohort was 38 years (interquartile range [IQR], 32-45 years), 62% were female, 80% had Hb SS or Sβ0-thalassemia genotype, and 44% were on hydroxyurea therapy. The median BMI of the cohort was 25 kg/m2 (IQR, 22-30 kg/m2). With respect to socioeconomic indicators, 34% (31/92) had high school or less education, 80% (74/92) did not own their residence, 45% (43/95) were unemployed or unable to work, and 68% (53/78) had income of &lt; $35,000/year. The median DCI for our cohort was 86.5 (IQR, 67.1-94.9) with 61% (61/100) living in a distressed community (DCI &gt;80).
The median energy from dietary fat intake was 32.6% of daily calories (IQR, 30.8%-35.9%), which is consistent with the Department of Health and Human Services (DHS) guideline of 20%-35%, and similar to the national average of 35.8%. Only 1% (1/92) had a low-fat diet, defined as less than 20% of daily calories, and 29% (27/92) had a high fat diet, defined as more than 35% of daily calories. Perception of dietary fat intake correlated with actual calculated intake (r = 0.35, P = 0.001). The median fruit and vegetable servings consumed by the cohort was 2.0 serving sizes per day (IQR, 1.0-3.4 servings), which is lower than the Centers for Disease and Control (CDC) Prevention daily dietary recommendation of 5 servings/day, and below the national and state-level (Illinois) average of 2.6 servings/day in the general population (PMID 34990439). Only 16% (15/93) of our cohort met the CDC daily recommendations of fruits and vegetables.
Living in the most distressed tier (DCI &gt;80) was associated with higher fat intake (β = 0.1±0.03; p = 0.004) but not with fruit and vegetable intake (p = 0.9). Unemployment (β = 0.09±0.04; p = 0.01), lower annual household income (β = 0.09±0.04; p = 0.04), and high school or less education (β = 0.06±0.04; p = 0.1) were also associated with higher fat intake. The individual-level socioeconomic indices were not associated with fruit and vegetable consumption (P ≥ 0.2).

Conclusions
In this study, we demonstrated that adults with SCD have a dietary fat intake similar to the general U.S. adult population, but fruit and vegetables intake well below the recommended and national and state-levels. Furthermore, our SCD patients experienced a high burden of socioeconomic distress with both individual and community-level indicators being significantly associated with a higher dietary fat intake. Increased dietary fat and low fruit and vegetable consumption are associated with worse cardiorenal outcomes in the general population. Our findings highlight the need for further investigation to better understand barriers for healthy eating in people with SCD. Future studies are also needed to elucidate the impact of individual-level socioeconomic factors and diet on cardiorenal health in SCD.