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Nutritional status of children with acute lymphoblastic leukemia: a longitudinal study
L Delbecque-Boussard1, F Gottrand, S Ategbo
1Department of Pediatrics, University Hospital of Lille, France.
Insights
Children with acute lymphoblastic leukemia showed reduced energy intake during chemotherapy, but their resting energy expenditure remained stable. Nutritional status did not decline significantly in the short term, suggesting adaptive mechanisms.
Area of Science:
- Pediatric Oncology
- Nutritional Science
- Metabolic Research
Background:
- Acute lymphoblastic leukemia (ALL) and its treatment can impact a child's nutritional status.
- Understanding these nutritional consequences is crucial for supportive care.
Purpose of the Study:
- To evaluate the nutritional consequences of ALL and chemotherapy in children.
- To assess changes in body composition, energy intake, and resting energy expenditure (REE).
Main Methods:
- Studied 15 children with ALL and 15 healthy controls.
- Measured anthropometrics, body composition (impedance), energy intake, and REE at diagnosis and during treatment (days 22, 36, 71).
- Monitored cytokines (IL-1 beta, IL-6, interferon-gamma, TNF).
Main Results:
- Patients had lower energy and carbohydrate intake during the first month of chemotherapy compared to controls.
- Energy and carbohydrate intake improved during treatment.
- Resting energy expenditure (REE) and body composition remained comparable between patients and controls throughout the study.
- Nonprotein respiratory quotient (RQ) was transiently lower in patients, suggesting adaptation to poor carbohydrate intake.
Conclusions:
- Children with ALL did not exhibit increased REE or significant short-term undernutrition during the initial 71 days of chemotherapy.
- Temporary decreases in energy intake were observed but did not lead to immediate adverse body composition changes.
- Further long-term nutritional assessment is recommended.
Abstract:
To evaluate the nutritional consequences of acute lymphoblastic leukemia and its treatment, 15 children with leukemia were studied. Anthropometric data, fat-free mass by impedance, energy intake, and resting energy expenditure (REE) were determined at diagnosis and on days 22, 36, and 71 of the treatment. Interleukin (IL)-1 beta, IL-6, interferon-gamma, and tumor necrosis factor were also measured. Fifteen healthy control subjects were matched for age and sex. Body weight and height and body composition were comparable at all times of the study, although three children were underweight at diagnosis (weight-for-height < 85% of French standards). Although two different methods were used for dietary recall in the two groups, energy intake expressed as a percentage of normal recommended values for age and sex was lower in patients than in control subjects (104 +/- 19%) on day 1 (47 +/- 32.1%) and day 22 (58 +/- 24%), but was comparable on day 36 (85 +/- 71%) and day 71 (85 +/- 48%). This low energy intake involved both carbohydrates and fats. Energy and carbohydrate intakes improved significantly during the study in patients. The nonprotein respiratory quotient (RQ) in patients was significantly lower than in control subjects (0.84 +/- 0.04) on day 1 (0.79 +/- 0.02) but was comparable on day 71. The REE of the patients on day 1 (5057.8 +/- 1588.4 kJ/24 h) and day 71 (4844.7 +/- 116.1 kJ/24 h) and of the control subjects (4313.8 +/- 823.5 kJ/24 h) was not significantly different. Cytokines remained undetectable on days 1, 36, and 71. The results showed that at the time of diagnosis and during this period of chemotherapy there was no evidence of raised REE. The poor intakes during the first month of chemotherapy were recent as shown by the parents' questionnaire responses and the absence of consequences in body composition. The transient decrease in RQ seemed to be an adaptative mechanism to the poor carbohydrate intake. No indication of undernutrition in the patients as a group was evident during the first 71 d of treatment although further long-term nutritional assessment is needed.