Impact of nutritional source modality on weight loss and BMI reduction after hematopoietic stem cell transplantation

Deterioration of nutritional status in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients is associated with increased morbidity. Enteral nutrition (EN) has been associated with more favorable outcomes than total parenteral nutrition (TPN); however, TPN remains the first-line nutritional source in many pediatric transplant centers because of health providers and caregiver limitations and biases. Oral nutritional (ON) source may help overcome these limitations, but evidence supporting efficacy in allo-HSCT recipients is currently lacking. We retrospectively evaluated the impact of three nutritional source modalities (ON, EN, and parenteral nutrition) on nutritional status in 125 children undergoing allo-HSCT in two Italian pediatric centers. Secondary endpoints included associations between nutrition modality and several allo-HSCT outcomes: time to engraftment, length of hospitalization, and incidence of acute graft-versus-host disease (aGvHD). A total of 41 patients received TPN, 47/125 received ON, and 37/125 received EN. Patients supported by EN experienced a significantly lower body mass index (BMI) decrease compared to others (-0.45; range -2.18 to 3.95; IQR -0.67 to -0.15 kg/m²; p < 0.05), while a significantly higher decrease occurred in patients who received TPN compared to all others (-1.1; range -9.86 to 0.58; IQR -1.78 to -0.36; p < 0.05); ON was associated with an intermediate outcome (-0.91; range -4.09 to 12.29; IQR -1.66 to -0.06). BMI decrease is greater in male patients (p < 0.05). The length of hospitalization was strongly correlated with nutritional support (p < 0.001), with EN associated with the lowest median time of admission length. Nutrition support modality did not significantly correlate with severe aGvHD in our analysis, nor was there correlation with time to neutrophil or platelet engraftment.