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Prognostic Factors in the Resumption of Oral Dietary Intake After Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Children

Lori J. Bechard, MEd, RD, LDN^*,, Eva C. Guinan, MD^*,, Henry A. Feldman, PhD^*, Vivian Tang, BS^* and Christopher Duggan, MD, MPH^*

From the ^* Children's Hospital Boston, Boston, Massachusetts; and Dana Farber Cancer Institute, Boston, Massachusetts

Correspondence: Christopher Duggan, MD, MPH, Clinical Nutrition Service, Division of GI/Nutrition, Children's Hospital, Boston, 300 Longwood Avenue, Boston, MA 02115. Electronic mail may be sent to christopher.duggan{at}childrens.harvard.edu.

Background: Parenteral nutrition (PN) is a common supportive care therapy in patients undergoing hematopoietic stem cell transplantation (HSCT). Inadequate oral dietary intake may necessitate prolonged courses of PN, which have been associated with metabolic, infectious, and hepatobiliary complications. The objective of this study was to identify demographic, clinical, and nutrition factors associated with the resumption of oral dietary intake following HSCT. Methods: This was an observational cohort study of 37 children undergoing allogeneic HSCT. Repeated-measures regression analysis was performed to identify factors associated with the resumption and macronutrient composition of oral nutrient intake after HSCT. Results: Mean oral dietary intake during the first 2 weeks after HSCT was <280 kcal/d. At all times, oral carbohydrate intake was high, ranging from 58% to 74% of oral energy. Age, time since transplant, degree of oral mucositis, and severity of graft-vs-host disease (GVHD) were all significantly correlated with the resumption of oral energy intake, as well as oral intake of carbohydrates. Oral protein and fat intake were also associated with elapsed time since HSCT, severity of mucositis, and GVHD. Factors not associated with oral dietary intake included gender, pre-HSCT nutrition status, diagnosis, type of donor, and infections. Conclusions: Children undergoing HSCT exhibit a marked reduction in oral dietary intake and a preference for a diet high in carbohydrates. Careful attention should be directed to the oral dietary intake and nutrient requirements of children during HSCT, especially in younger patients and those who experience severe mucositis or GVHD.

Journal of Parenteral and Enteral Nutrition, Vol. 31, No. 4, 295-301 (2007)
DOI: 10.1177/0148607107031004295


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