Abstract
Accepted 16 April 1997
Nutritional insult after bone marrow transplantation (BMT) is complex and its nutritional management challenging. Enteral nutrition is cheaper and easier to provide than parenteral nutrition, but its tolerance and effectiveness in reversing nutritional depletion after BMT is poorly defined. Nutritional status, wellbeing, and nutritional biochemistry were prospectively assessed in 21 children (mean age 7.5 years; 14 boys) who received nasogastric feeding after BMT (mean duration 17 days) and in eight children (mean age 8 years, four boys) who refused enteral nutrition and who received dietetic advice only. Enteral nutrition was stopped prematurely in eight patients. Greater changes in weight and mid upper arm circumference were observed in the enteral nutrition group, while positive correlations were found between the duration of feeds and increase in weight and in mid upper arm circumference. Vomiting and diarrhoea had a similar incidence in the two groups, while fever and positive blood cultures occurred more frequently in the dietetic advice group. Diarrhoea occurring during enteral nutrition was not associated with fat malabsorption, while carbohydrate malabsorption was associated with rotavirus infection only. Enteral feeding did not, however, affect bone marrow recovery, hospital stay, general wellbeing, or serum albumin concentrations. Hypomagnesaemia, hypophosphataemia, zinc and selenium deficiency were common in both groups. In conclusion, enteral nutrition, when tolerated, is effective in limiting nutritional insult after BMT. With existing regimens nutritional biochemistry should be closely monitored in order to provide supplements when required.
Full Text
The Full Text of this article is available as a PDF (125.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Antila H. M., Salo M. S., Kirvelä O., Näntö V., Rajamäki A., Toivanen A. Serum trace element concentrations and iron metabolism in allogeneic bone marrow transplant recipients. Ann Med. 1992 Feb;24(1):55–59. doi: 10.3109/07853899209164145. [DOI] [PubMed] [Google Scholar]
- Apelgren K. N., Wilmore D. W. Parenteral nutrition: is it oncologically logical? A response. J Clin Oncol. 1984 May;2(5):539–541. doi: 10.1200/JCO.1984.2.5.539. [DOI] [PubMed] [Google Scholar]
- Berger M. M., Cavadini C., Chiolero R., Dirren H. Copper, selenium, and zinc status and balances after major trauma. J Trauma. 1996 Jan;40(1):103–109. doi: 10.1097/00005373-199601000-00019. [DOI] [PubMed] [Google Scholar]
- Block J. B., Chlebowski R. T., Herrold J. N. Continuous enteric alimentation with a blenderized formula in cancer cachexia. Clin Oncol. 1981 Jun;7(2):93–98. [PubMed] [Google Scholar]
- Bounous G., Le Bel E., Shuster J., Gold P., Tahan W. T., Bastin E. Dietary protection during radiation therapy. Strahlentherapie. 1975 May;149(5):476–483. [PubMed] [Google Scholar]
- Day D. L., Carpenter B. L. Abdominal complications in pediatric bone marrow transplant recipients. Radiographics. 1993 Sep;13(5):1101–1112. doi: 10.1148/radiographics.13.5.8210593. [DOI] [PubMed] [Google Scholar]
- Donaldson S. S. Nutritional support as an adjunct to radiation therapy. JPEN J Parenter Enteral Nutr. 1984 May-Jun;8(3):302–310. doi: 10.1177/0148607184008003302. [DOI] [PubMed] [Google Scholar]
- Donaldson S. S., Wesley M. N., DeWys W. D., Suskind R. M., Jaffe N., vanEys J. A study of the nutritional status of pediatric cancer patients. Am J Dis Child. 1981 Dec;135(12):1107–1112. doi: 10.1001/archpedi.1981.02130360015007. [DOI] [PubMed] [Google Scholar]
- Evans T. R., Harper C. L., Beveridge I. G., Wastnage R., Mansi J. L. A randomised study to determine whether routine intravenous magnesium supplements are necessary in patients receiving cisplatin chemotherapy with continuous infusion 5-fluorouracil. Eur J Cancer. 1995;31A(2):174–178. doi: 10.1016/0959-8049(94)00420-a. [DOI] [PubMed] [Google Scholar]
- Fosså S. D., Lehne G., Heimdal K., Theodorsen L. Clinical and biochemical long-term toxicity after postoperative cisplatin-based chemotherapy in patients with low-stage testicular cancer. Oncology. 1995 Jul-Aug;52(4):300–305. doi: 10.1159/000227478. [DOI] [PubMed] [Google Scholar]
- Frisancho A. R. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981 Nov;34(11):2540–2545. doi: 10.1093/ajcn/34.11.2540. [DOI] [PubMed] [Google Scholar]
- Goyens P., Otten J. Problèmes nutritionnels crés par les traitements anticancéreux chez l'enfant. Rev Med Brux. 1983 Apr;4(4):333–337. [PubMed] [Google Scholar]
- Guiot H. F., Biemond J., Klasen E., Gratama J. W., Kramps J. A., Zwaan F. E. Protein loss during acute graft-versus-host disease: diagnostic and clinical significance. Eur J Haematol. 1987 Feb;38(2):187–196. doi: 10.1111/j.1600-0609.1987.tb01160.x. [DOI] [PubMed] [Google Scholar]
- Halton J., Atkinson S. A., Bradley C., Dawson S., Barr R. D. Acute lymphoid leukemia. No evidence of consistent chemotherapy-induced intestinal malabsorption. Am J Pediatr Hematol Oncol. 1993 Aug;15(3):271–276. [PubMed] [Google Scholar]
- Hays D. M., Merritt R. J., White L., Ashley J., Siegel S. E. Effect of total parenteral nutrition on marrow recovery during induction therapy for acute nonlymphocytic leukemia in childhood. Med Pediatr Oncol. 1983;11(2):134–140. doi: 10.1002/mpo.2950110213. [DOI] [PubMed] [Google Scholar]
- Inoue S., Epstein M. D., Alexander J. W., Trocki O., Jacobs P., Gura P. Prevention of yeast translocation across the gut by a single enteral feeding after burn injury. JPEN J Parenter Enteral Nutr. 1989 Nov-Dec;13(6):565–571. doi: 10.1177/0148607189013006565. [DOI] [PubMed] [Google Scholar]
- Itokawa Y. [Trace elements in long-term total parenteral nutrition]. Nihon Rinsho. 1996 Jan;54(1):172–178. [PubMed] [Google Scholar]
- Johnston I. D., Wright P. D., Lennard T. W., Clague M. B., Carmichael M. J., Francis D. M., Williams R. H. Malnutrition and cancer. Clin Oncol. 1981 Jun;7(2):83–91. [PubMed] [Google Scholar]
- Lansky S. B., List M. A., Lansky L. L., Ritter-Sterr C., Miller D. R. The measurement of performance in childhood cancer patients. Cancer. 1987 Oct 1;60(7):1651–1656. doi: 10.1002/1097-0142(19871001)60:7<1651::aid-cncr2820600738>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
- Lukens J. N. Supportive care for children with cancer. Guidelines of the Childrens Cancer Study Group. The use of nutritional therapy. Am J Pediatr Hematol Oncol. 1984 Fall;6(3):261–265. [PubMed] [Google Scholar]
- McAnena O. J., Rossi M., Mehta B. M., Daly J. M. Alteration of methotrexate metabolism in rats by administration of an elemental liquid diet. I. Changes in drug enterohepatic circulation. Cancer. 1987 Jan 1;59(1):31–37. doi: 10.1002/1097-0142(19870101)59:1<31::aid-cncr2820590111>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
- Merritt R. J., Kalsch M., Roux L. D., Ashley-Mills J., Siegel S. S. Significance of hypoalbuminemia in pediatric oncology patients--malnutrition or infection? JPEN J Parenter Enteral Nutr. 1985 May-Jun;9(3):303–306. doi: 10.1177/0148607185009003303. [DOI] [PubMed] [Google Scholar]
- Moore F. A., Moore E. E., Jones T. N., McCroskey B. L., Peterson V. M. TEN versus TPN following major abdominal trauma--reduced septic morbidity. J Trauma. 1989 Jul;29(7):916–923. doi: 10.1097/00005373-198907000-00003. [DOI] [PubMed] [Google Scholar]
- Motil K. J., Altchuler S. I., Grand R. J. Mineral balance during nutritional supplementation in adolescents with Crohn disease and growth failure. J Pediatr. 1985 Sep;107(3):473–479. doi: 10.1016/s0022-3476(85)80537-0. [DOI] [PubMed] [Google Scholar]
- Mulder P. O., Bouman J. G., Gietema J. A., Van Rijsbergen H., Mulder N. H., Van der Geest S., De Vries E. G. Hyperalimentation in autologous bone marrow transplantation for solid tumors. Comparison of total parenteral versus partial parenteral plus enteral nutrition. Cancer. 1989 Nov 15;64(10):2045–2052. doi: 10.1002/1097-0142(19891115)64:10<2045::aid-cncr2820641013>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
- Papadopoulou A., Lloyd D. R., Williams M. D., Darbyshire P. J., Booth I. W. Gastrointestinal and nutritional sequelae of bone marrow transplantation. Arch Dis Child. 1996 Sep;75(3):208–213. doi: 10.1136/adc.75.3.208. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Papadopoulou A., Nathavitharana K., Williams M. D., Darbyshire P. J., Booth I. W. Diagnosis and clinical associations of zinc depletion following bone marrow transplantation. Arch Dis Child. 1996 Apr;74(4):328–331. doi: 10.1136/adc.74.4.328. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Payne-James J., de Gara C., Grimble G., Rees R., Bray J., Rana S., Cribb R., Frost P., Silk D. Nutritional support in hospitals in the United Kingdom: national survey 1988. Health Trends. 1990;22(1):9–13. [PubMed] [Google Scholar]
- Rawashdeh M. O., Lloyd D. R., Puntis J. W., Brown G. A., Booth I. W. Using the steatocrit to determine optimal fat content in modular feeds. Arch Dis Child. 1992 May;67(5):608–612. doi: 10.1136/adc.67.5.608. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rickard K. A., Becker M. C., Loghmani E., Grosfeld J. L., Godshall B. J., Weetman R. M., Coates T. D., Lingard C. D., White N. M., Foland B. B. Effectiveness of two methods of parenteral nutrition support in improving muscle mass of children with neuroblastoma or Wilms' tumor. A randomized study. Cancer. 1989 Jul 1;64(1):116–125. doi: 10.1002/1097-0142(19890701)64:1<116::aid-cncr2820640121>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
- Rickard K. A., Godshall B. J., Loghmani E. S., Coates T. D., Grosfeld J. L., Weetman R. M., Lingard C. D., Foland B. B., Yu P. L., McGuire W. Integration of nutrition support into oncologic treatment protocols for high and low nutritional risk children with Wilms' tumor. A prospective randomized study. Cancer. 1989 Jul 15;64(2):491–509. doi: 10.1002/1097-0142(19890715)64:2<491::aid-cncr2820640224>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
- Rickard K. A., Grosfeld J. L., Kirksey A., Ballantine T. V., Baehner R. L. Reversal of protein-energy malnutrition in children during treatment of advanced neoplastic disease. Ann Surg. 1979 Dec;190(6):771–781. doi: 10.1097/00000658-197912000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rickard K. A., Kirksey A., Baehner R. L., Grosfeld J. L., Provisor A., Weetman R. M., Boxer L. A., Ballantine T. V. Effectiveness of enteral and parenteral nutrition in the nutritional management of children with Wilms' tumors. Am J Clin Nutr. 1980 Dec;33(12):2622–2629. doi: 10.1093/ajcn/33.12.2622. [DOI] [PubMed] [Google Scholar]
- Ringwald-Smith K., Krance R., Stricklin L. Enteral nutrition support in a child after bone marrow transplantation. Nutr Clin Pract. 1995 Aug;10(4):140–143. doi: 10.1177/0115426595010004140. [DOI] [PubMed] [Google Scholar]
- Shamberger R. C., Pizzo P. A., Goodgame J. T., Jr, Lowry S. F., Maher M. M., Wesley R. A., Brennan M. F. The effect of total parenteral nutrition on chemotherapy-induced myelosuppression. A randomized study. Am J Med. 1983 Jan;74(1):40–48. doi: 10.1016/0002-9343(83)91116-6. [DOI] [PubMed] [Google Scholar]
- Szeluga D. J., Stuart R. K., Brookmeyer R., Utermohlen V., Santos G. W. Nutritional support of bone marrow transplant recipients: a prospective, randomized clinical trial comparing total parenteral nutrition to an enteral feeding program. Cancer Res. 1987 Jun 15;47(12):3309–3316. [PubMed] [Google Scholar]
- Taj M. M., Pearson A. D., Mumford D. B., Price L. Effect of nutritional status on the incidence of infection in childhood cancer. Pediatr Hematol Oncol. 1993 Jul-Sep;10(3):283–287. doi: 10.3109/08880019309029498. [DOI] [PubMed] [Google Scholar]
- Weisdorf S. A., Salati L. M., Longsdorf J. A., Ramsay N. K., Sharp H. L. Graft-versus-host disease of the intestine: a protein losing enteropathy characterized by fecal alpha 1-antitrypsin. Gastroenterology. 1983 Nov;85(5):1076–1081. [PubMed] [Google Scholar]
- Weisdorf S., Hofland C., Sharp H. L., Teasley K., Schissel K., McGlave P. B., Ramsay N., Kersey J. Total parenteral nutrition in bone marrow transplantation: a clinical evaluation. J Pediatr Gastroenterol Nutr. 1984;3(1):95–100. doi: 10.1097/00005176-198401000-00020. [DOI] [PubMed] [Google Scholar]
- van Eys J., Copeland E. M., Cangir A., Taylor G., Teitell-Cohen B., Carter P., Ortiz C. A clinical trial of hyperalimentation in children with metastatic malignancies. Med Pediatr Oncol. 1980;8(1):63–73. doi: 10.1002/mpo.2950080110. [DOI] [PubMed] [Google Scholar]
- van Eys J. Nutrition and cancer: physiological interrelationships. Annu Rev Nutr. 1985;5:435–461. doi: 10.1146/annurev.nu.05.070185.002251. [DOI] [PubMed] [Google Scholar]
- van Eys J. The pathophysiology of undernutrition in the child with cancer. Cancer. 1986 Oct 15;58(8 Suppl):1874–1880. doi: 10.1002/1097-0142(19861015)58:8+<1874::aid-cncr2820581414>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]