Changes in nutritional status and associations with physical and clinical outcomes in acute myeloid leukemia patients during intensive chemotherapy.

Autor: van Lieshout R; Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands. r.vanlieshout@mmc.nl., Tick LW; Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands., Beckers EAM; Department of Internal Medicine, Division Hematology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands., Biesbroek W; Department of Dietetics and Nutrition, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands., Dieleman JP; Department of Research, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands., Dijkstra M; Department of Physiotherapy, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands., Groenesteijn W; Department of Physiotherapy, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands., Koene HR; Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands., Kranenburg S; Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands., van der Lee D; Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands., van der Put-van den Berg L; Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands., Rademakers N; Department of Physiotherapy, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands., Regelink JC; Department of Internal Medicine, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands., van Tilborg CJ; Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands., Westerweel PE; Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands., de Zeeuw S; Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands., Schouten HC; Department of Internal Medicine, Division Hematology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands., Beijer S; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.; Department of Dietetics and Nutrition, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: European journal of clinical nutrition [Eur J Clin Nutr] 2024 Dec; Vol. 78 (12), pp. 1082-1094. Date of Electronic Publication: 2024 Aug 10.
DOI: 10.1038/s41430-024-01488-8
Abstrakt: Background/objectives: Patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) often receive medical nutrition therapy (MNT) during intensive remission-induction treatment. Since little is known about changes in nutritional status, specifically body composition, in this patient population, these changes and their associations with physical and clinical outcomes were assessed.
Subjects/methods: In this multicenter prospective observational study, newly diagnosed AML/MDS patients who received intensive remission-induction chemotherapy, routine dietary counseling by a dietician and MNT immediately upon inadequate nutritional intake, were included. At treatment initiation and discharge, nutritional status, including Patient-Generated Subjective Global Assessment (PG-SGA)-scores and body composition, physical outcomes and fatigue were assessed. Associations of nutritional status/body composition with physical outcomes, fatigue, fever duration, number of complications, time to neutrophil engraftment and hospital length of stay (LOS) (collected from medical records) were examined using multiple regression analysis.
Results: In >91% of the 126 AML/MDS patients included, nutritional intake was adequate, with 61% receiving MNT. Nevertheless, body weight decreased significantly (p < 0.001) and mainly consisted of a loss of muscle/fat-free mass (FFM) (p < 0.001), while fat mass (FM) remained unchanged (p-value range = 0.71-0.77). Body weight and waist circumference showed significant negative associations with fever duration and/or number of complications. Significant positive associations were found between mid-upper arm muscle circumference (MUAMC) and physical functioning and between PG-SGA-scores and fatigue. Body weight and MUAMC were also negatively associated with LOS.
Conclusion: Despite MNT in AML/MDS patients undergoing intensive chemotherapy, muscle/FFM decreased while FM remained unchanged. Maintenance of nutritional status was associated with improved physical and clinical outcomes.
Competing Interests: Competing interests: RvL has received unrestricted research grants from the Vrienden Integrale Oncologische Zorg Foundation, Utrecht, The Netherlands, Baxter B.V. Utrecht, The Netherlands (Grand reference number: GHOL6759) (Category 1), and Fresenius Kabi Nederland B.V., Huis ter Heide, The Netherlands (Category 1). C.J.v.T., S.d.Z. and P.E.W. have received an unrestricted research grant from the Albert Schweitzer Hospital’s Research Fund, Dordrecht, The Netherlands. The other authors have nothing to disclose. Ethical approval: The study protocol was reviewed and exempted from ethics approval by the Medical Ethics Committee Maxima MC (N17025). The study procedures were in accordance with the rules of the European Personal Data Protection Act and the Code of Ethics of the World Medical Association (Helsinki Declaration). The study was registered at The Dutch Trial Register (NTR) with trial number NL8505. Written informed consent was obtained from all patients prior to enrollment in the study.
(© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)
Databáze: MEDLINE
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