Body composition changes in marrow transplant recipients receiving total parenteral nutrition

Abstract

Nine patients with acute lymphocytic leukemia in remission, aged 12-35 years, undergoing allogeneic bone marrow transplantation (BMT) were studied for changes in body fluid balance and body composition. Body composition and fluids were assessed the first 4 weeks following BMT, using isotope dilution and anthropometry. Oral and parenteral nutrient intakes were recorded daily. Tracer dilution techniques were used to assess body fluid volumes and estimate body cell, lean body, and body fat masses. Body cell mass was lost (mean -1.62 kg, P less than 0.05) without significant changes in body fat or lean body masses. There was an expansion of the extracellular fluid compartment (mean +0.8 l, P less than 0.05) and a loss in the intracellular fluid compartment (mean -1.3 l, P less than 0.05) with little change in total body water volume. Changes in body weight correlated poorly with body cell mass or fluid volume changes. Change in arm muscle area correlated well with changes in body cell mass (r = 0.61, P less than 0.05) and lean body mass (r = 0.68, P less than 0.05), while that of arm fat area did not reflect its isotope dilution-derived counterpart. Instead, the change in arm fat area was related to shifts in fluid compartments. Prealbumin decreased significantly (mean -9.3 mg/dl, P less than 0.05), while albumin decreased slightly (mean -0.1 mg/dl), and both were related to changes in body cell mass. Nitrogen balance was negative throughout the study and the overall mean was related to the change in body cell mass (r = 0.60, P less than 0.05). Calorie and protein intakes were not associated with the changes in body composition, implying other causal factors.

Total parenteral nutrition vs oral diet in autologous hematopoietic cell transplant recipients

“…[18][19][20] In our study, prophylactic TPN resulted in better preservation of nutritional status and protein stores, while the OD led to depletion in protein stores. This is demonstrated by the greater decreases in weight, MAMC, and HGS seen in the OD group compared to the TPN group.…”

Longitudinal follow-up of nutritional status and its influencing factors in adults undergoing allogeneic hematopoietic cell transplantation

“…A major limitation of these quick tools (BMI, SGA questionnaire) is that relevant changes in body composition (for example, loss of fat-free mass, mainly due to muscle atrophy) can be disguised by an increase in fat mass or fluid retention leading to stable overall weight, 50 which is highlighted by a small study in alloHCT patients showing significant fluid shifts to extracellular space, along with significant body cell mass loss till day þ 30, whereby body weight and fat mass remained constant. 51 This brings into focus the proposal that body composition measurements such as bioelectrical impedance analysis, muscular strength and/or mid-arm muscle circumference are indicated for the assessment of nutritional status in these patients.…”

Nutritional considerations in children undergoing bone marrow transplantation

“…The administration of uids may sometimes lead to over-hydration, while diarrhoea and vomiting may lead to dehydration. Both situations reduce the reliability of weight-related indices in assessing nutritional status (Cheney et al, 1987). Moreover, weight frequently remains stable despite negative nitrogen balance and loss of lean body mass owing to changes in hydration (Cittere et al, 1983).…”

“…Anthropometry can be useful in BMT patients if measurements are obtained serially (Cheney et al, 1987). Midarm circumference (MAC), is said to be the most reliable anthropometric index in children with solid tumours (Smith et al, 1990), while skinfold measurements are also considered helpful in assessing changes in body stores of muscle and fat (Frisancho & Flegel, 1982).…”

“…With this method, total body water and extracellular¯uid volume are measured using 3 H 2 O and 82 Br respectively as tracers, and body cell mass is calculated afterwards using various calculation methods. Cheney et al reported that body weight correlated poorly with body cell mass or¯uid volume changes, assessed using tracer dilution techniques, in a group of 9 patients aged 12 ± 35 years undergoing BMT (Cheney et al, 1987). However, a good correlation was reported between changes in arm muscle area and changes in body cell mass.…”