DETERMINANTS OF SHORT STATURE IN CHILDREN WITH TRANSFUSION-DEPENDENT THALASSEMIA: A CROSS-SECTIONAL STUDY IN INDONESIA

Abstract

Thalassemia-related iron overload and malnutrition contribute substantially to growth impairment among children with transfusion-dependent thalassemia (TDT). This study aimed to analyze the prevalence and determinants of short stature in pediatric TDT patients. A cross-sectional study was conducted among 120 children aged 24–216 months at Dr. Cipto Mangunkusumo Hospital, Jakarta, between August and December 2023 using consecutive sampling. Nutritional status was assessed using height-for-age and mid-upper arm circumference (MUAC) Z-scores based on WHO standards. Clinical data, including pre-transfusion hemoglobin and serum ferritin levels, were obtained from medical records. Statistical analyses included Chi-square and multivariate logistic regression tests. The prevalence of short stature was 39.2%, while malnutrition prevalence reached 56.7%. Multivariate analysis demonstrated that malnutrition based on MUAC (OR=5.02; 95% CI:1.88–13.44; p=0.001), transfusion frequency ≥2 weeks (OR=3.59; 95% CI:1.40–9.21; p=0.008), and serum ferritin ≥3500 µg/L (OR=3.55; 95% CI:1.22–10.34; p=0.020) were independently associated with short stature. Malnutrition, intensive transfusion frequency, and iron overload were identified as significant determinants of short stature among children with TDT. Routine nutritional assessment using MUAC and optimal iron chelation management should be integrated into thalassemia care to prevent growth impairment.

Keywords: thalassemia, short stature, ferritin, malnutrition, growth failure

ABSTRAK

Kelebihan zat besi dan malnutrisi terkait talasemia memberikan kontribusi besar terhadap gangguan pertumbuhan pada anak-anak dengan talasemia yang membutuhkan transfusi (TDT). Studi ini bertujuan untuk menganalisis prevalensi dan faktor penentu perawakan pendek pada pasien TDT anak. Studi potong lintang dilakukan pada 120 anak berusia 24–216 bulan di Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta, antara Agustus dan Desember 2023 menggunakan pengambilan sampel berurutan. Status gizi dinilai menggunakan skor Z tinggi badan menurut usia dan lingkar lengan atas (MUAC) berdasarkan standar WHO. Data klinis, termasuk kadar hemoglobin dan feritin serum sebelum transfusi, diperoleh dari rekam medis. Analisis statistik meliputi uji Chi-square dan regresi logistik multivariat. Prevalensi perawakan pendek adalah 39,2%, sedangkan prevalensi malnutrisi mencapai 56,7%. Analisis multivariat menunjukkan bahwa malnutrisi berdasarkan MUAC (OR=5,02; 95% CI:1,88–13,44; p=0,001), frekuensi transfusi ≥2 minggu (OR=3,59; 95% CI:1,40–9,21; p=0,008), dan feritin serum ≥3500 µg/L (OR=3,55; 95% CI:1,22–10,34; p=0,020) secara independen berhubungan dengan perawakan pendek. Malnutrisi, frekuensi transfusi intensif, dan kelebihan zat besi diidentifikasi sebagai penentu signifikan perawakan pendek di antara anak-anak dengan TDT. Penilaian nutrisi rutin menggunakan MUAC dan manajemen khelasi zat besi yang optimal harus diintegrasikan ke dalam perawatan talasemia untuk mencegah gangguan pertumbuhan.

Kata kunci: talasemia, perawakan pendek, feritin, malnutrisi, gangguan pertumbuhan