title: Relationship between chronic transfusion therapy and body composition in subjects with thalassemia.
abstract: OBJECTIVE
  To measure body composition in patients with thalassemia and explore its relationship to abnormal growth and bone mass.
  
  
  METHODS
  We conducted a cross-sectional, multicenter study. Fat, lean, and bone mineral density (BMD) were assessed with dual-energy x-ray absorptiometry. Medical history, food frequency, and physical activity questionnaires were conducted in 257 transfused patients with thalassemia (age, 23.7+/-11 years [mean+/-SD]; 51% male) compared with 113 non-transfused patients (21.3+/-13 years; 44% male).
  
  
  RESULTS
  Subjects with thalassemia were leaner compared with healthy American subjects from National Health and Nutrition Examination Survey III data. Transfused subjects had a higher percentage of body fat compared with non-transfused subjects after controlling for age, sex, and ethnicity; 11.8% of non-transfused pediatric subjects were considered underweight, significantly lower than National Health and Nutrition Examination Survey data (P=.03). Hemoglobin level was positively related to lean mass (P=.008). Body fat and lean mass were positive predictors for both height and BMD z-scores after adjustment for transfusion status, age, sex, ethnicity, calcium intake, and physical activity (all P<.001).
  
  
  CONCLUSIONS
  Although most adult patients with thalassemia had healthy body composition with rare obesity, young non-transfused patients appear at risk for being underweight. Optimizing physical activity and appropriate use of transfusion therapy may improve growth and bone health in these patients who are at-risk for being underweight.
authors.affiliation: Department of Hematology, Children's Hospital & Research Center, Oakland, CA, USA.
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Fung
authors.forename: Yan
authors.initials: Y
authors.lastname: Xu
authors.forename: Janet L
authors.initials: JL
authors.lastname: Kwiatkowski
authors.forename: Maria G
authors.initials: MG
authors.lastname: Vogiatzi
authors.forename: Ellis
authors.initials: E
authors.lastname: Neufeld
authors.forename: Nancy
authors.initials: N
authors.lastname: Olivieri
authors.forename: Elliott P
authors.initials: EP
authors.lastname: Vichinsky
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Giardina
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001823:Body Composition; D001827:Body Height; D015519:Bone Density; D002136:Calcium, Dietary / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007006:Hypogonadism / Q000453:epidemiology; D007501:Iron / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013789:Thalassemia / Q000453:epidemiology* / Q000378:metabolism; D013997:Time Factors; D014807:Vitamin D / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D002136:Calcium, Dietary; D014807:Vitamin D; D007501:Iron