Dietary intake and childhood leukemia: The Diet and Acute Lymphoblastic Leukemia Treatment (DALLT) cohort study

Abstract

Objective Children with acute lymphoblastic leukemia (ALL) are at elevated risk for nutrition-related morbidity both during and after therapy. We present the demographic characteristics and nutrient intake at study entry of a prospective cohort in which evaluating dietary intake in children diagnosed with ALL was investigated. Methods Dietary intake data were collected for participants enrolled on the Dana-Farber Cancer Institute ALL Consortium Protocol. Dietary intake was assessed with a food frequency questionnaire and was compared with the dietary reference intake by ALL risk group (standard and high risk). Results Dietary intake data were collected from 81% of participants (n = 640). We found that 27% of participants were overweight/obese. Intake of total calories and other nutrients exceeded the dietary reference intake in up to 79% of children. This was evident in both risk groups and was pronounced among younger children. For micronutrients, dietary intake of calcium, vitamin D (females only), and zinc differed significantly between patients with standard-risk and those with high-risk ALL. Conclusions This study was successful in collecting dietary intake data at the time of cancer diagnosis in a multicenter setting in a pediatric population at high-risk for nutrition-related morbidity. We identified “at-risk” dietary intakes, which vary by sex and ALL risk group; such patients may benefit from future dietary interventions.

Psychosocial determinants of physical activity and dietary behaviors in adolescents and young adults with cancer and survivors

“…Finally, despite our restricted analysis for dietary components, our study concurs with previous studies demonstrating very few patients meet dietary recommendations. A mere 10% of participants met dietary guidelines for fruits and vegetables; a figure lower than previously reported data and aligned with others . In the light of the increased risk of nutrition‐related morbidities, our results reflect an opportunity for intervention to further health outcomes among this at‐risk population …”

“…Recent evidence has demonstrated the feasibility of exercise‐based interventions during the intensive phase of treatment . Additional data are needed on the feasibility of lifestyle change during different treatment phases . Treatment of cancer may be an optimal time for dietary and exercise interventions especially if interventions are incorporated into existing treatment protocols and approached as other routine supportive care interventions …”

An investigation of toxicities and survival in Hispanic children and adolescents with ALL: Results from the Dana‐Farber Cancer Institute ALL Consortium protocol 05‐001

“…Considering the observation of both reduced toxicities and inferior survival in the Hispanic cohort, the possibility of suboptimal drug exposure in these patients likely deserves further inquiry. Thus, while differences in both host and leukemia biology are prognostically important, future studies will also focus on host pharmacogenomics, detailed analyses of nutrition status and obesity trends, interpatient differences in biomarkers of drug exposure, frequency of drug interruptions for toxicity, and oral chemotherapy adherence.…”

A decrease in vitamin D levels is associated with methotrexate-induced oral mucositis in children with acute lymphoblastic leukemia

“…The main sources of vitamin D are production in the skin through sunlight exposure, diet, and vitamin D supplements [7,11]. Vitamin D (D 2 Children with ALL may be at increased risk of vitamin D deficiency due to impaired sun exposure and impaired vitamin intake [12]. A retrospective study in 86 pediatric cancer patients with a median age of 7 years revealed vitamin D deficiency in 63% at diagnosis [13].…”