Grant: Project Grant

Sickle cell disease is a blood disorder that is passed down from parents to their children. People with sickle cell disease cannot make healthy red blood cells and have an increased risk of illness and death. Folate is a B-vitamin needed to make proteins in our body and to help proteins function in our body. Sickle cell disease causes children to have higher folate needs than healthy children. Currently, children with sickle cell disease take 1-6 mg/day of folic acid (the man-made form of folate). However, even the lowest recommended dose of 1 mg/d folic acid provides six times more folate than is recommended for healthy children aged 1-3 years. There is growing concern that high amounts of synthetic folic acid may be harmful in the long term, as it may interfere with how natural folate works in the body, and it is associated with an increased risk of some types of cancers. We will study the effectiveness and potential risk of folic acid supplementation in 36 children (2-19 years of age) with sickle cell disease who are attending BC Children's Hospital. Children will receive 1 mg/d folic acid or a placebo for 12 weeks. After a 12-week washout period (no supplements), the treatments will be reversed. Blood samples will be collected at baseline and after 12 weeks of each treatment. We will measure several different forms of folate in the blood, hemoglobin, vitamins B12 and B6, and other clinical outcomes (anemia and pain crises) in children. Our study will be the first-step towards determining if the recommendation for high-dose folic acid supplementation in children with sickle cell disease requires re-evaluation. Our overall goal is to improve the nutritional status and clinical care of Canadian children with sickle cell disease.