Nutritional status and energy expenditure in children pre-bone-marrow-transplant

White, Mary; Murphy, Alexia J.; Hastings, Yvonne; Shergold, J; Young, Jeanine; Montgomery, Colette; Davies, Peter S. W.; Lockwood, Liane

doi:10.1038/sj.bmt.1704891

Cited by 36 publications

(30 citation statements)

References 17 publications

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“…White et al 13 recently discovered that BMI grossly underestimated the severity of malnutrition in children in the transplant population when compared to body cell mass (BCM). According to their study, when evaluated with BMI alone, 14% of their transplant population was considered malnourished whereas 56% would be considered malnourished if using BCM.…”

Section: Discussionmentioning

confidence: 99%

Weight loss and reduced body mass index: a critical issue in children with multiorgan chronic graft-versus-host disease

Browning

Thormann

Seshadri

et al. 2006

Bone Marrow Transplant

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Weight loss and malnutrition are major problems in patients with chronic graft-versus-host disease (GVHD). In adults, low body mass index (BMI) is a predictor for mortality; however, weight loss and BMI have not been studied in pediatric chronic GVHD. A retrospective study on 18 children with extensive chronic GVHD was completed. Median age at SCT was 12.3 (range 0.6-23) years; age at chronic GVHD diagnosis was 12.5 (1-23) years. Patients with multiorgan involvement had a mean maximal decrease in BMI of 20.9% and most dropped below 10th percentile in expected weight-for-age. This change in BMI not only indicates a significant decrease in weight but often a plateau in stature. In contrast, patients with one organ system involved had a mean maximal decrease in BMI of 5% and did not fall below 10th percentile. All patients with multiorgan involvement required salvage therapy beyond steroids and CSA. Three patients died due to complications of chronic GVHD. Weight loss and malnutrition (as reflected by a decrease in BMI) are clinically significant issues in children with multisystem chronic GVHD. Weight loss is likely another systemic manifestation of the disease and may contribute, along with other factors such as increased immunosuppression and infection, to increased mortality in this group.

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Section: Discussionmentioning

confidence: 99%

Weight loss and reduced body mass index: a critical issue in children with multiorgan chronic graft-versus-host disease

Browning

Thormann

Seshadri

et al. 2006

Bone Marrow Transplant

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show abstract

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Urbain

Birlinger

Lambert

et al. 2012

Bone Marrow Transplant

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There are few longitudinal data on nutritional status and body composition of patients undergoing allogeneic hematopoietic cell transplantation (alloHCT). We assessed nutritional status of 105 patients before alloHCT and its course during the early posttransplant period to day þ 30 and day þ 100 via weight history, body mass index (BMI) normalized for gender and age, Subjective Global Assessment, phase angle normalized for gender, age, and BMI, and fat-free and body fat masses. Furthermore, we present a multivariate regression model investigating the impact of factors on body weight. At admission, 23.8% reported significant weight losses (45%) in the previous 6 months, and we noted 31.5% with abnormal age-and sex-adjusted BMI values (p10th, X90th percentiles). BMI decreased significantly (Po0.0001) in both periods by 11% in total, meaning a weight loss of 8.6 ± 5.7 kg. Simultaneously, the patients experienced significant losses (Po0.0001) of both fat-free and body fat masses. Multivariate regression model revealed clinically relevant acute GVHD (parameter estimate 1.43; P ¼ 0.02) and moderate/severe anorexia (parameter estimate 1.07; P ¼ 0.058) as independent factors influencing early weight loss. In conclusion, our results show a significant deterioration in nutritional status during the early post-transplant period. Predominant alloHCT-associated complications such as anorexia and acute GVHD became evident as significant factors influencing nutritional status.

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“…Fluctuations resulting from fluid overload were detected and were corrected quickly. As previously reported, the presence of fluid rather than lean muscle mass challenges the assumption that weight is an accurate indicator of nutritional status (Cheney et al, 1987;White et al, 2005). A mean of 32% of daily energy requirements was met via nasogastric feeds, although weight fluctuations from admission until discharge were insignificant.…”

Section: Discussionmentioning

confidence: 90%

Enteral Nutrition and Bone Marrow Transplantation

Hastings

White

Young

2006

J Pediatr Oncol Nurs

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This retrospective study evaluated the efficacy of enteral nutrition for pediatric patients undergoing the challenging treatment of allogeneic bone marrow transplantation. During the period from January 1999 to May 2000, 15 patients were transplant recipients. On admission to the hospital, 87% of patients were above the 50th percentile for weight for age. Nasogastric tubes were inserted while platelet counts remained greater than 50 x 10(9) mL/L. A specialized elemental formula for pediatric patients was commenced. These feeds were administered continuously and were titrated until caloric requirement or tolerance level had been achieved. During hospitalization for bone marrow transplantation, enteral nutrition was the major form of nutritional support for all patients. Enteral feeds continued even during maximal gut toxicity and were supported with antiemetics and analgesia. There were insignificant weight fluctuations during hospitalization, with 80% of children above the 50th percentile weight for age being discharged. Enteral nutrition via a nasogastric tube was effective in the provision of nutrition during bone marrow transplantation and continues to have an important role in this unit.

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Nutritional status and energy expenditure in children pre-bone-marrow-transplant

Cited by 36 publications

References 17 publications

Weight loss and reduced body mass index: a critical issue in children with multiorgan chronic graft-versus-host disease

Weight loss and reduced body mass index: a critical issue in children with multiorgan chronic graft-versus-host disease

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

Enteral Nutrition and Bone Marrow Transplantation

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