title: Low antioxidant vitamin intakes are associated with increases in adverse effects of chemotherapy in children with acute lymphoblastic leukemia.
abstract: BACKGROUND
  Chemotherapy leads to an increase in reactive oxygen species, which stresses the antioxidant defense system. Children with acute lymphoblastic leukemia rarely are overtly malnourished, which makes this population ideal for an investigation of the relations between dietary antioxidant consumption, plasma antioxidant concentrations, and chemotherapy-induced toxicity.
  
  
  OBJECTIVE
  This study was conducted to investigate the effect of therapy on antioxidant intakes in children with acute lymphoblastic leukemia, the relation between dietary antioxidant intakes and plasma antioxidant concentrations, and the relation between the incidence of side effects due to treatment and antioxidant intake.
  
  
  METHODS
  We conducted a 6-mo observational study of 103 children with acute lymphoblastic leukemia. Plasma micronutrient concentrations, dietary intakes, and incidence of side effects of chemotherapy were ascertained at diagnosis and after 3 and 6 mo of therapy.
  
  
  RESULTS
  Throughout the 6-mo study period, subjects ingested vitamin E, total carotenoid, beta-carotene, and vitamin A in amounts that were 66%, 30%, 59%, and 29%, respectively, of the US recommended dietary allowance or of the amounts specified in the third National Health and Nutrition Examination Survey. Greater vitamin C intakes at 6 mo were associated with fewer therapy delays, less toxicity, and fewer days spent in the hospital. Greater vitamin E intakes at 3 mo were associated with a lower incidence of infection. Greater beta-carotene intakes at 6 mo were associated with a decreased risk of toxicity.
  
  
  CONCLUSIONS
  A large percentage of children undergoing treatment for acute lymphoblastic leukemia have inadequate intakes of antioxidants and vitamin A. Lower intakes of antioxidants are associated with increases in the adverse side effects of chemotherapy.
authors.affiliation: Division of Pediatric Oncology, Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA.
authors.forename: Deborah D
authors.initials: DD
authors.lastname: Kennedy
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Tucker
authors.forename: Elena D
authors.initials: ED
authors.lastname: Ladas
authors.forename: Susan R
authors.initials: SR
authors.lastname: Rheingold
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Blumberg
authors.forename: Kara M
authors.initials: KM
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000975:Antioxidants / Q000008:administration & dosage*; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000097:blood; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008499:Medical Records; D018529:Nutritional Support; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000188:drug therapy*; D011446:Prospective Studies; D012044:Regression Analysis; D014810:Vitamin E / Q000008:administration & dosage / Q000097:blood
chemical_list: D000970:Antineoplastic Agents; D000975:Antioxidants; D014810:Vitamin E; D001205:Ascorbic Acid