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https://ptsldigital.ukm.my/jspui/handle/123456789/519835Full metadata record
| DC Field | Value | Language |
|---|---|---|
| dc.contributor.advisor | Professor Dr. Suzana Shahar | |
| dc.contributor.author | Mirhosseini. Naghmeh Zahra (P43373 ) | |
| dc.date.accessioned | 2023-10-17T09:30:27Z | - |
| dc.date.available | 2023-10-17T09:30:27Z | - |
| dc.date.issued | 2012-06-16 | |
| dc.identifier.other | ukmvital:81495 | |
| dc.identifier.uri | https://ptsldigital.ukm.my/jspui/handle/123456789/519835 | - |
| dc.description | Beta Thalassemia syndromes are the most common hereditary hemoglubinopathies. The life expectancy of patients with Thalassemia has greatly improved over the last decade; however, abnormal growth and low bone mineral density are the common features among patients suffering from transfusion-dependent ß Thalassemia. The objective of this study was to determine the effect of zinc supplement on growth and bone health in paediatric patients with transfusion-dependent β Thalassemia. This study was conducted in two phases. The first phase (screening phase) was a crosssectional study among 140 paediatric thalassemia patients aged 8 to 18 years at Sarvar clinic in Mashhad. Anthropometric, food intake, biochemical (bone-related parameters, trace minerals and ferritin) and bone densitometry (DXA scan) measurements were taken on all subjects. The second phase (intervention phase), a randomised double-blinded placebo-controlled study (RCT), was performed on 109 subjects who completed screening phase and fulfilled the inclusion criteria for intervention. Subjects were randomized to receive either zinc (30 mg zinc sulphate) or placebo for 9 months. The follow up were done at 3, 6 and 9 month. Malnutrition, as assessed using body mass index (BMI), was seen in 44% of boys and 19.7% of girls. Short stature was present in approximately 44% and 37 % of boys and girls, respectively. Total energy intake of subjects met 54% of recommended dietary allowance in boys and 60% in girls. Zinc deficiency was seen in 70% and 55% of boys and girls, respectively. Hypocalcaemia and vitamin D deficiency were present in 22% and 85% of subjects, respectively. Low bone mineral density at lumbar spine and femoral areas was shown in 82% and 52% of subjects, respectively. Older age was a positive predictor for BMI. A greater body weight, older age and a higher level of serum calcium were positive predictors for lumbar BMD and BMC, while puberty was a negative predictor. Height and age were positive predictors but serum osteocalcin and puberty were negative predictors for BMD and BMC, in femoral area (p < 0.05 for all parameters). Results of the RCT showed that zinc supplementation improved nutritional status of girls via significant increment in the anthropometric parameters included height, weight, BMI, triceps skinfold thickness and waist circumference (p < 0.05 for all parameters). Only height was improved in boys (p<0.05). The mean of forearm length and wrist circumference increased in zinc supplemented group, as compared to placebo (p < 0.05 for both parameters). A higher percentage of zinc supplemented group rated as good or very good appetite at 9 months intervention, as compared to placebo (p < 0.0.5 for all parameters). In conclusion, malnutrition, zinc deficiency, low bone mineral density, hypocalcemia and vitamin D deficiency were prevalent in β Thalassemia patients. Zinc supplementation could improve the nutritional status of these patients, especially among girls. A desirable improvement was seen on dimensional growth of bone of the zinc supplemented subjects. There is a need to recognise poor nutritional status and bone health among paediatric thalassemia patients, for appropriate nutrition intervention.,Sindrom beta talasemia adalah penyakit keturunan berkaitan hemoglobin yang paling biasa ditemui. Sejak sedekad lalu, jangkahayat pesakit talasemia telah meningkat, walau bagaimanpun, keabnormalan pertumbuhan dan kepadatan mineral tulang yang rendah adalah antara masalah yang biasa ditemui di kalangan pesakit beta talasemia yang bergantung kepada rawatan transfusi darah. Objektif kajian ini adalah untuk menentukan kesan suplimentasi zink ke atas pertumbuhan dan kesihatan tulang di kalangan pesakit beta talasemia yang bergantung kepada rawatan transfusi darah. Kajian ini terbahagi kepada dua fasa. Fasa pertama (fasa saringan) melibatkan kajian hirisan lintang di kalangan 140 pesakit talasemia pediatrik berumur antara 8 hingga 18 tahun di klinik Sarvar di Mashhad. Antropometri, rekod pengambilan makanan, penilaian biokimia (parameter berkaitan tulang, unsur surih dan feritin) dan ujian kepadatan tulang (imbasan DXA) semua subjek diukur. Fasa kedua (fasa intervensi) melibatkan kajian kawalan placebo double-blind telah dijalankan ke atas 109 subjek yang telah melengkapkan fasa saringan serta memenuhi kriteria pemilihan untuk intervensi. Subjek dibahagikan secara rawak untuk menerima samada suplimen zink (30mg zink sulfat) atau placebo selama 9 bulan. Lawatan susulan telah dijalankan pada bulan ke-3, ke-6 dan ke-9. Malpemakanan, yang dinilai menggunakan indeks jisim tubuh (IJT), dapat dilihat pada 44% subjek lelaki dan 19.7% subjek perempuan. Kerencatan pertumbuhan hadir pada 44% subjek lelaki dan 37% subjek perempuan. Jumlah pengambilan tenaga memenuhi 54% saranan pemakanan di kalangan subjek lelaki dan 60% bagi perempuan. Masalah kekurangan zink didapati berlaku di kalangan 70% subjek lelaki dan 55% subjek perempuan. Hipokalsemia dan kekurangan vitamin D dilihat pada 22% dan 85% subjek lelaki dan perempuan masing-masing. Kepadatan tulang rendah di kawasan tulang lumbar dan femoral dilihat pada 82% dan 52% subjek masing-masing. Usia yang lebih tua adalah faktor penentu BMI yang positif. Berat badan yang tinggi,tua dan kepekatan kalsium yang tinggi adalah penentu yang positif untuk BMD dan BMC lumbar, manakala penentu negative pada puberty. Tinggi dan umur adalah penentu positif, tetapi ia adalah penentu negative bagi puberti dan pada serum ostacalcin bagi BMD dan BMC pada tulang femoral (p<0.05 bagi semua parameter). Keputusan ujian klinikal rawak menunjukkan bahawa pemberian suplimen zink meningkatkan status pemakanan subjek perempuan melalui peningkatan parameter antropometri yang signifikan termasuklah tinggi, berat, IJT, ketebalan lipatan trisep dan ukurlilit pinggang (p<0.05 bagi semua parameter). Bagi subjek lelaki, hanya parameter tinggi yang meningkat (p<0.05). Min panjang lengan dan ukurlilit pergelangan tangan meningkat bagi kumpulan yang menerima zink, berbanding placebo (p<0.05 bagi semua parameter). Kumpulan yang menerima suplimen zink mencatatkan peratusan yang lebih tinggi dalam pengundian tahap selera makan bagus atau sangat bagus selepas 9 bulan fasa intervensi, berbanding placebo (p<0.05) bagi semua parameter). Kesimpulannya, malpemakanan, kekurangan zink, ketumpatan mineral tulang yang rendah, hipokalsemia dan kekurangan vitamin D adalah prevalen di kalangan pesakit beta talasemia. Pemberian suplimen zink boleh meningkatkan status pemakanan pesakit ini, terutamanya di kalangan perempuan. Peningkatan yang diingini dapat dilihat pada dimensi pertumbuhan tulang subjek yang menerima suplimen zink. Oleh itu, terdapatnya keperluan untuk mengenalpasti status pemakanan dan kesihatan tulang yang rendah di kalangan pesakit talasemia pediatrik untuk menentukan intervensi pemakanan yang sesuai.,Ph.D | |
| dc.language.iso | eng | |
| dc.publisher | UKM, Kuala Lumpur | |
| dc.relation | Faculty of Health Sciences / Fakulti Sains Kesihatan | |
| dc.rights | UKM | |
| dc.subject | Beta Thalassemia syndromes | |
| dc.subject | Transfusion-dependent | |
| dc.subject | Zinc supplement | |
| dc.subject | Dissertations, Academic -- Malaysia | |
| dc.title | The efficacy of zinc supplementation on growth and bone health in Pediatric patients with transfusion-dependent beta Thalassemia in Iran | |
| dc.type | Theses | |
| dc.format.pages | 300 | |
| dc.identifier.callno | WH170 .M675e 2012 9 | |
| dc.identifier.barcode | 001694 | |
| Appears in Collections: | Faculty of Health Sciences / Fakulti Sains Kesihatan | |
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| File | Description | Size | Format | |
|---|---|---|---|---|
| ukmvital_81495+SOURCE1+SOURCE1.0.PDF Restricted Access | 5.29 MB | Adobe PDF |  View/Open |
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