Elena J Ladas1, Manuela Orjuela2, Kristen Stevenson3, Peter D Cole4, Meiko Lin5, Uma H Athale6, Luis A Clavell7, Jean-Marie Leclerc8, Caroline Laverdiere8, Bruno Michon9, Marshall A Schorin10, Jennifer Greene Welch11, Barbara L Asselin12, Stephen E Sallan3, Lewis B Silverman3, Kara M Kelly13. 1. Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY, United States; Institute of Human Nutrition, Columbia University, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, United States. Electronic address: ejd14@cumc.columbia.edu. 2. Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, United States. 3. Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA, United States. 4. Albert Einstein College of Medicine, Bronx, NY, United States; Rutgers Cancer Institute of New Jersey, United States. 5. Teachers College, Columbia University, United States. 6. Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada. 7. San Jorge Children's Hospital, San Juan, PR, United States. 8. Hematology-Oncology Division, Charles Bruneau Cancer Center, Sainte-Justine University Hospital, University of Montreal, Montreal, QC, Canada. 9. Centre Hospitalier Universitaire de Quebec, Sainte-Foy, QC, Canada. 10. Inova Children's Hospital, Falls Church, VA, United States. 11. Division of Pediatric Hematology/Oncology, Hasbro Children's Hospital, Brown University, Providence, RI, United States. 12. Department of Pediatrics, University of Rochester School of Medicine, Golisano Children's Hospital at URMC, Rochester, NY, United States. 13. Department of Pediatrics, Roswell Park Cancer Institute and University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States.
Abstract
BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Nutritional morbidities are a persistent problem facing pediatric patients during and after treatment and age-gender groups that are at risk for nutritional conditions have not been clearly identified. Therapy is a contributing factor; however, the role of dietary intake remains largely unknown. Prior to conduct of interventional trials, an understanding of the effects of treatment on fluctuations in dietary intake is necessary. METHODS: We enrolled 794 children with ALL in a prospective clinical trial. Dietary intake was collected with a food frequency questionnaire at diagnosis and throughout the course of treatment for pediatric ALL. Reported values were compared to the Dietary Recommended Intake (DRI), and normative values (NHANES). Hierarchical linear models and multilevel mixed-effects ordered logistic regression models were used to evaluate longitudinal changes in dietary intake; independent samples t-test with Bonferroni correction was performed to compare to NHANES. RESULTS: Of the evaluable participants at each timepoint, dietary intake was obtained on 81% (n = 640), 74% (n = 580) and 74% (n = 558) at diagnosis, end of induction phase of treatment, and continuation, respectively. Despite exposure to corticosteroids, caloric intake decreased over therapy for most age-gender groups. Predictive models of excess intake found reduced odds of over-consuming calories (OR 0.738, P < 0.05); however, increased odds of over-consuming fat (OR 6.971, P < 0.001). When compared to NHANES, we consistently found that ≥1/3 of children were consuming calories in excess of normative values. For select micronutrients, a small proportion of participants were above or below the DRI at each time evaluated. CONCLUSIONS: Our study suggests that dietary intake fluctuates during treatment for ALL as compared to age-gender recommended and normative values. Improving our understanding of nutrient fluctuations and dietary quality will facilitate subsequent analyses addressing relationships of dietary intake, toxicity, and survival. Crown
BACKGROUND:Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Nutritional morbidities are a persistent problem facing pediatric patients during and after treatment and age-gender groups that are at risk for nutritional conditions have not been clearly identified. Therapy is a contributing factor; however, the role of dietary intake remains largely unknown. Prior to conduct of interventional trials, an understanding of the effects of treatment on fluctuations in dietary intake is necessary. METHODS: We enrolled 794 children with ALL in a prospective clinical trial. Dietary intake was collected with a food frequency questionnaire at diagnosis and throughout the course of treatment for pediatric ALL. Reported values were compared to the Dietary Recommended Intake (DRI), and normative values (NHANES). Hierarchical linear models and multilevel mixed-effects ordered logistic regression models were used to evaluate longitudinal changes in dietary intake; independent samples t-test with Bonferroni correction was performed to compare to NHANES. RESULTS: Of the evaluable participants at each timepoint, dietary intake was obtained on 81% (n = 640), 74% (n = 580) and 74% (n = 558) at diagnosis, end of induction phase of treatment, and continuation, respectively. Despite exposure to corticosteroids, caloric intake decreased over therapy for most age-gender groups. Predictive models of excess intake found reduced odds of over-consuming calories (OR 0.738, P < 0.05); however, increased odds of over-consuming fat (OR 6.971, P < 0.001). When compared to NHANES, we consistently found that ≥1/3 of children were consuming calories in excess of normative values. For select micronutrients, a small proportion of participants were above or below the DRI at each time evaluated. CONCLUSIONS: Our study suggests that dietary intake fluctuates during treatment for ALL as compared to age-gender recommended and normative values. Improving our understanding of nutrient fluctuations and dietary quality will facilitate subsequent analyses addressing relationships of dietary intake, toxicity, and survival. Crown