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Published on: February 16, 2024
Body Composition, Bone Health, and Dietary Intake in Children After Allogeneic Hematopoietic Stem Cell
Janne Anita Kvammen1,2, Rut Anne Thomassen1,2, Kristin Godang3
1Department of Pediatric Medicine, Oslo University Hospital, 0424 Oslo, Norway.
Insights
Pediatric stem cell transplant patients show poorer body composition and bone health compared to healthy children, highlighting the need for nutritional monitoring.
Area of Science:
- Pediatric Hematology/Oncology
- Nutritional Science
- Bone Health Research
Background:
- Allogeneic hematopoietic stem cell transplantation (HSCT) can impact long-term growth and development in pediatric patients.
- Understanding body composition, bone mineral density (BMD), and dietary intake is crucial for post-transplant recovery and health.
- Limited data exists comparing these parameters in pediatric HSCT survivors to healthy controls.
Purpose of the Study:
- To compare body composition, BMD, and dietary intake between pediatric patients post-allogeneic HSCT and healthy children.
- To evaluate changes in these parameters at 3 months and 1 year after transplantation.
- To identify specific nutritional deficiencies or excesses in HSCT survivors.
Main Methods:
- Prospective observational study design.
- Dual-energy X-ray absorptiometry (DXA) for assessing appendicular lean mass index (ALMI), fat mass index (FMI), fat mass percentage (FM%), and BMD.
- 4-day dietary records to evaluate nutrient intake at 3 months and 1 year post-transplant.
- Comparison with age-matched healthy children assessed using identical methods.
Main Results:
- At 1 year post-HSCT, patients exhibited significantly lower ALMI and BMD (total body less head) Z-scores compared to controls.
- Patients showed higher FMI and FM% Z-scores at 1 year, indicating altered body composition.
- While dietary intake improved, fiber intake remained lower in patients, with notable variations in fat, calcium, and vitamin D intake.
Conclusions:
- Pediatric HSCT survivors present with less favorable body composition and impaired bone health compared to healthy peers.
- Nutritional status improves post-transplant, but specific nutrient intakes require attention.
- Ongoing nutritional support and monitoring are essential for optimizing long-term outcomes in pediatric HSCT patients.
Abstract:
Background/Objectives: This study describes body composition, bone mineral density (BMD), and dietary intake in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation compared to healthy children. Methods: In this prospective observational study, dual-energy X-ray absorptiometry was used to assess appendicular lean mass index (ALMI), fat mass index (FMI), fat mass percentage (FM%), and BMD, and a 4-day dietary record was used to assess dietary intake at 3 months and 1 year post-transplant. Healthy children were assessed once by the same methods. Results: We included 28 patients (mean 10.3 years, SD 4.0) and 50 healthy children (mean 10.0 years, SD 3.6). At 1 year, median Z-scores were lower for ALMI (-1.34 vs. 0.40, p < 0.001), higher for FMI (0.34 vs. -0.33, p < 0.012) and FM% (0.59 vs. -0.98, p < 0.001), lower for BMD total body less head (-1.0 vs. 0.3, p = 0.006), but similar for BMD spine compared to healthy children. At 1 year, 9/15 (60%) had ALMI Z-score ≤ -1, 6/15 (40%) had FMI Z-score ≥ 1, 5/15 (33%) had FM% Z-score ≥ 1, and 8/18 (53%) had BMD total body less head Z-score ≤ -1, and 3/15 (20%) had BMD spine Z-score ≤ -1. Dietary intake improved, and at 1 year, energy and protein intakes were comparable, fat, calcium, and vitamin D intakes were higher, but fiber intake remained lower in patients than in healthy children. Conclusions: Patients had a more unfavorable body composition and bone health. Dietary intake improved from 3 months to 1 year post-transplant. However, the results indicate a need for nutritional follow-up, particularly targeting protein, fat, fiber, calcium, and vitamin D.
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