Nutritional Status and Clinical Severity in Children with Sickle Cell Disease and Confirmed Asthma: A Multicentre Observational Study

Background and Objective Children with sickle cell disease (SCD) frequently experience chronic inflammation, increased metabolic demands, and recurrent acute complications. Asthma is a recognized comorbidity associated with increased morbidity in SCD. However, the contribution of nutritional status particularly body mass index (BMI) to clinical severity among children with SCD and confirmed asthma remains poorly documented, especially in tropical settings. The objective of this study was to describe the nutritional status of children with SCD and spirometry-confirmed asthma and to assess the association between BMI-for-age z-scores and clinical severity. Methods We conducted a multicentre observational study including children aged 5–17 years with SCD and spirometry-confirmed asthma. Nutritional status was assessed using WHO 2007 BMI-for-age z-scores calculated from measured weight and height. Undernutrition was defined as a BMI-for-age z-score < − 2. Clinical severity was defined as the occurrence of at least two hospitalizations for vaso-occlusive crises and/or acute chest syndrome in the preceding 12 months. Associations between nutritional indicators and clinical severity were evaluated using bivariate and multivariable logistic regression models adjusted for relevant clinical covariates. Results were summarized in three tables and an adjusted forest plot. Results A total of 138 children were included (median age 8.0 years). Overall, 17.4% presented undernutrition, while 12.3% were overweight or obese, highlighting a heterogeneous nutritional profile. In bivariate analyses, undernutrition was more frequent among children with severe disease compared to those with non-severe disease (24.5% vs 13.5%). When analyzed as a continuous variable, lower BMI-for-age z-scores were significantly associated with increased odds of severe disease (OR per 1-SD decrease = 1.34). After multivariable adjustment, the association between BMI-for-age z-score and severity was attenuated but remained suggestive of a biologically plausible dose response relationship. Conclusion In children with sickle cell disease and confirmed asthma, clinical severity is primarily driven by respiratory burden, particularly acute chest syndrome, while lower BMI-for-age z-scores reflect global systemic vulnerability rather than an independent risk factor. Routine nutritional assessment may therefore support risk stratification and help identify children who could benefit from targeted multidisciplinary care.