Changes in resting energy expenditure among children undergoing allogeneic stem cell transplantation.
BACKGROUND
Because of the effects of chemotherapy and radiotherapy, patients undergoing stem cell transplantation (SCT) are commonly provided nutritional support with parenteral nutrition. The energy and nutrient needs of these patients have not been well studied.


OBJECTIVE
The objective was to measure resting energy expenditure (REE), dietary intake, and biochemical and anthropometric changes in children before and after allogeneic SCT.


METHODS
This was a prospective cohort study of 37 children aged 9.1 +/- 6.4 y ( +/- SD) undergoing SCT who were enrolled in an open-label trial of a unique supportive care intervention that included the routine use of oral leucovorin, vitamin E, and ursodeoxycholic acid. Parenteral nutrition was provided to match 100% of measured or estimated REE. REE was measured weekly via indirect calorimetry.


RESULTS
Baseline REE was 95% of the predicted age- and sex-matched norms and was significantly correlated with midarm muscle area (r = 0.82, P < 0.001). REE fell to a nadir of approximately 80% of the predicted levels by week 3 after SCT, with a gradual increase in weeks 4 and 5. Arm anthropometric measurements showed no change in triceps skinfold thickness but significant declines in midarm muscle area after SCT. Serum vitamin E remained in the normal range.


CONCLUSIONS
Children undergoing SCT show significant declines in REE after transplantation. These changes may be due to alterations in lean body mass. Standard nutritional regimens may lead to overfeeding.
Duggan
Christopher
C
Clinical Nutrition Service, Division of GI/Nutrition, Children's Hospital, Boston, MA 02115, USA. christopher.duggan@tch.harvard.edu
Bechard
Lori
L
Donovan
Kate
K
Vangel
Mark
M
O'Leary
Alice
A
Holmes
Colleen
C
Lehmann
Leslie
L
Guinan
Eva
E
D000293:Adolescent; D000886:Anthropometry; D001132:Arm; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D009132:Muscles / Q000033:anatomy & histology; D011184:Postoperative Period; D011446:Prospective Studies; D012146:Rest; D012885:Skinfold Thickness; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous