Early Body Mass Index z ‐Score Change and Resolution of Severe Malnutrition in Children With Sickle Cell Anemia in a Low‐Income Setting: A Prospective Single‐Arm Extension Study

Background Children with sickle cell anemia (SCA) in low‐income settings are at risk of severe malnutrition, but optimal nutritional management has not been established. We evaluated an intensified ready‐to‐use therapeutic food (RUTF) regimen in children with persistent severe malnutrition after initial treatment and assessed whether early change in body mass index z ‐score (BMIZ) was prognostic of later resolution of severe malnutrition. Procedure Children aged 5–12 years with SCA and BMIZ less than −3.0 after 12 weeks of supplemental RUTF received higher intensity, weight‐based RUTF plus hydroxyurea through Week 24. We examined whether the change in BMIZ from baseline to Week 4 was associated with the resolution of severe malnutrition (BMIZ ≥−3.0) by Week 12 or, among extension participants, by Week 24. Results Of 108 children, 66 (61%) entered the extension. During Weeks 12–24, 11 of 66 (17%) achieved resolution, increasing the cumulative proportion with BMIZ ≥−3.0 from 39% (42/108) at Week 12 to 49% (53/108) by Week 24. Greater improvement in BMIZ from baseline to Week 4 was associated with higher odds of resolution by Week 12 or, among extension participants, by Week 24 (OR 12.38; p < 0.001), whereas older age was associated with lower odds of resolution (OR 0.72; p = 0.006). Among extension participants, higher Week‐12 BMIZ was associated with higher odds of Week‐24 resolution (OR 14.44; p = 0.039). Conclusions In children with SCA and severe malnutrition, early BMIZ improvement in this small, single‐arm extension was associated with later resolution of severe malnutrition, and may help risk‐stratify children who need earlier reassessment or alternative management, a prognostic signal that warrants prospective testing rather than an immediate change in practice.