KÜBRA TEL ADIGÜZEL, ORHAN GÜRSEL, HÜLYA GÖKMEN ÖZEL

Lösemili Çocuklarda Beslenme Durumu: Tedavi Dönemi ile Tedavi Sonrası Dönem Farklı Mıdır?

Amaç: Akut lenfoblastik lösemi (ALL) nedeniyle tedavi görmekte olan çocuklar ile tedavisi tamamlanarak izlem sürecine alınmış çocukların beslenme durumlarını karşılaştırmaktır. Bireyler ve Yöntem: Bu araştırmaya Gülhane Eğitim Araştırma Hastanesi Çocuk Hastalıkları Hematoloji Kliniğinde ALL tanısı ile tedavi görmekte olan (Grup A) ve tedavisi tamamlanarak kontrol amacıyla polikliniğe başvuran (Grup B) 4-13 yaş aralığındaki toplam 26 çocuk dâhil edilmiştir. Ebeveynlere çocukların bilgilerine ilişkin genel bilgi soru formu uygulanmış, üç günlük 24-saatlik besin tüketim kaydı alınmış ve çocukların antropometrik ölçümleri [vücut ağırlığı, boy uzunluğu, triseps deri kıvrım kalınlığı (TDKK) ve üst orta kol çevresi (ÜOKÇ)] alınmıştır. Alınan ölçümlerden Beden Kütle İndeksi (BKİ) hesaplanmış ve çocuklar Dünya Sağlık Örgütü 2006 ve 2007 yaşa göre BKİ standartları ile değerlendirilmiştir. Çocukların ÜOKÇ ve TDKK ölçümlerinin değerlendirilmesinde Amerikan Ulusal Sağlık İstatistikleri Merkezi (NCHS) standartları kullanılmıştır. Çocukların dosyalarından hemoglobin, albümin ve total protein değerleri kaydedilmiştir. Bulgular: BKİ Z-skor dağılımına göre, A grubundaki çocukların %88.9'u (n=8) normal, %11.1'i (n=1) zayıftır. B grubunda ise çocukların %47.1'i (n=8) normal, %35.3'ü (n=6) hafif şişman ve %17.6'sı (n=3) obezdir. Z-skor dağılımında gruplar arasında anlamlı fark vardır (p= 0.04). Çocukların besin tüketim kayıtları değerlendirildiğinde A grubundaki çocukların %55.6'sı yetersiz enerji alırken, B grubundaki çocukların tamamı yeterli enerji almaktadır. Her iki gruptaki çocukların da yeterli protein aldıkları görülmektedir. Çocukların albümin, total protein ve hemoglobin değerlerinin A grubunda, B grubuna kıyasla daha düşük olduğu görülürken, bu farklılık, albümin ve hemoglobin düzeyleri açısından istatistiksel anlamlı düzeyde değildir. Sonuç: Lösemili çocukların beslenme durumlarının belirlenmesi ve düzenlenmesi gerek yaşam kalitesinin arttırılması, gerekse de büyüme-gelişme düzeylerinin takibi açısından önem taşımaktadır. Lösemili çocukların beslenme yönünden düzenli takibi sayesinde hem löseminin erken dönemlerinde hastalığa ve tedavi yan etkilerine bağlı gelişebilecek malnütrisyon hem de lösemi tedavisinin bitiminde yüksek enerji alımına bağlı gelişebilecek obezite açısından erken dönemde gerekli tedbirler alınabilecektir

Nutritional Status in Leukemia: Is There a Difference Between Treatment Period and Post-Treatment Period?

Aim: To compare the nutritional status of children receiving treatment for acute lymphoblastic leukemia (ALL) with survivors of ALL. Subjects and Methods: This study included children between 4-13 years of age who are receiving treatment with ALL diagnosis and who completed the treatment and applied to the clinic for control in the Gülhane Training and Research Hospital Pediatric Hematology Department. A questionnaire for general information was applied to the parents of the children to obtain information about their children, three-day 24-hour dietary records and anthropometric measurements [body weight, height, triceps skinfold thickness (TST), and mid-upper arm circumference (MUAC)] of the children were taken. Body mass index (BMI) was calculated from the measurements and the children were evaluated with WHO 2006 and 2007 BMI for age standards/references. NCHS standards have been used in the evaluation of children’s MUAC and TST measurements. Hemoglobin, albumin, and total protein levels of children were obtained from patient records. Results: According to BMI Z-score distribution, 88.9% (n= 8) of children in group A were normal and 11.1% (n= 1) were underweight. In group B, 47.1% (n= 8) of the children were normal, 35.3% (n= 6) were overweight and 17.6% (n= 3) were obese. There was a significant difference between the groups in the Z-score distribution (p= 0.04). When food consumption records of children were evaluated, it is found that 55.6% of children in group A had insufficient energy intake, while all children in group B had adequate energy intake. Protein intake of children in both group were adequate. Albumin, total protein and haemoglobin levels were lower in group A than group B but this difference was statistically significant for only albumin and haemoglobin levels. Conclusion: Determination and regulation of nutritional status of children with leukemia is important in terms of increasing quality of life, as well as the follow-up of growth and development. Regular monitoring of nutritional status of children with leukemia help to prevent both early malnutrition due to treatment side effects and early onset of obesity due to high energy intake, at the end of leukemia treatment

PDF

___

1. Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics. CA Cancer J Clin 2014;64:83–103.
2. Yazbeck N, Samia L, Saab R, Abboud MR, Solh H, Muwakkit S. Effect of malnutrition at diagnosis on clinical outcomes of children with acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2016;38(2):107- 110.
3. Bauer J, Jurgens H, Fruhwald MC. Important aspects of nutrition in children with cancer. Adv Nutr 2011;2:67- 77.
4. Esfahani A, Ghoreishi Z, Abedi Miran M, Sanaat Z, Ostadrahimi A, Eivazi Ziaei J, et al. Nutritional assessment of patients with acute leukemia during induction chemotherapy: association with hospital outcomes. Leuk Lymphoma 2014;55(8):1743-1750.
5. Linga VG, Shreedhara AK, Rau AT, Rau A. Nutritional assessment of children with hematological malignancies and their subsequent tolerance to chemotherapy. Ochsner J 2012;12:197-201.
6. Antillon F, Rossi E, Molina AL, Sala A, Pencharz P, Valsecchi MG, et al. Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala. Pediatr Blood Cancer 2013;60:911-915.
7. Pietsch JB, Ford C. Children with cancer: measurements of nutritional status at diagnosis. Nutr Clin Pract 2000;15:185-188.
8. Zimmermann K, Ammann RA, Kuehni CE, de Geest S, Cignacco E. Malnutrition in pediatric patients with cancer at diagnosis and throughout therapy: A multicenter cohort study. Pediatr Blood Cancer 2013;60:642-649.
9. Tan SY, Poh BK, Nadrah MH, Jannah NA, Rahman J, Ismail MN. Nutritional status and dietary intake of children with acute leukaemia during induction or consolidation chemotherapy. J Hum Nutr Diet 2013;26:23-33.
10. Karaman S. Pediatrik onkolojide tedaviye bağlı (endokrin) geç yan etkiler. Klinik Gelişim 2007;20;218- 227.
11. Pizzo P, Poplack D. Principles and Practice of Pediatric Oncology. Lippincott Williams & Wilkins, 2006.
12. Iughetti L, Bruzzi P, Predieri B, Paolucci P. Obesity in patients with acute lymphoblastic leukemia in childhood. Ital J Pediatr 2012;38:4.
13. Pekcan G. Beslenme Durumunun Saptanması (Eds: Baysal A, Aksoy M, Besler H.T, Bozkurt N, Keçecioğlu S, Kutluay Merdol T ve arkadaşları). Diyet El Kitabı. 5.baskı. Hatipoğlu Basın ve Yayım San.Tic.Ltd.Şti, Ankara, 2008. s. 67-142.
14. Merdol TK. Standart Yemek Tarifeleri: Toplu Beslenme Yapılan Kurumlar İçin. Ankara: Hatipoğlu Yayınevi. 2003.
15. Türkiye’ye Özgü Besin ve Beslenme Rehberi, 2015. Available at: http://www.bdb.hacettepe.edu.tr/TOBR_ kitap.pdf. Accessed July 18, 2017
16. Hayran M, Hayran M. Sağlık Araştırmaları için Temel İstatistik. 1.Baskı. Artrofset Matbaacılık Yayıncılık Organizasyon Ltd.Şti, Ankara, 2011.
17. Heuberger RA. Diseases of the Hematological System. In: Nutrition Therapy and Pathophysiology; NahikianNelms M, Sucher KP, Lacey K, Long Roth S (Eds), Wadsworth, Cengage Learning: Belmont, CA, USA, 2011. p.562-608.
18. Ethier MC, Alexander S, Abla O, Green G, Lam R, Sung L. Association betwee obesity at diagnosis and weight change during induction and survival in pediatric acute lymphoblastic leukemia. Leuk Lymphoma 2012;53:1677-1681.
19. Inaba H, Surprise HC, Pounds S, Cao X, Howard SC, Ringwald-Smith K, et al. Effect of body mass index on the outcome of children with acute myeloid leukemia. Cancer 2012;118:5989-5996.
20. Ladas EJ, Orjuela M, Stevenson K. Dietary intake and childhood leukemia: The diet and acute lymphoblastic leukemia treatment (DALLT) cohort study. Nutrition 2016;32:1103-1109.
21. Arpe ML, Rørvig S, Kok K, Mølgaard C, Frandsen TL. The association between glucocorticoid therapy and BMI z-score changes in children with acute lymphoblastic leukemia. Support Care Cancer 2015;23:3573-3580.
22. Shephard RJ. Body composition in biological anthropology. 1st ed. Cambridge, Cambridge University Press; 1991.
23. Gibson RS. Anthropometric assessment of body composition. In: Rosalind GS, editor. Principles of Nutritional Assessment. 1st ed. New York: Oxford University Press; 1990. p. 187-208.
24. Kumar R, Marwaha RK, Bhalla AK, Gulati M. Protein energy malnutrition and skeletal muscle wasting in childhood acute lymphoblastic leukemia. Indian Pediatr 2000;37:720-726.
25. Collins L, Beaumont L, Cranston A, Savoie S, Nayiager T, Barr R. Anthropometry in long-term survivors of acute lymphoblastic leukemia in childhood and adolescence. J Adolesc Young Adult Oncol 2017;6:294- 298.
26. Mariotto AB, Rowland JH, Yabroff KR, Scoppa S, Hachey M, Ries L, et al. Long-term survivors of childhood cancers in the United States. Cancer Epidemiol Biomarkers Prev 2009;18:1033-1040.
27. Robison LL, Hudson MM. Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nat Rev Cancer 2014;14:61-70.
28. Zhang FF, Kelly MJ, Saltzman E, Must A, Roberts SB, Parsons SK. Obesity in pediatric ALL survivors: a meta-analysis. Pediatrics 2014;133(3):e704-e715.
29. Zhang FF, Liu S, Chung M, Kelly MJ. Growth patterns during and after treatment in patients with pediatric ALL: a meta-analysis. Pediatr Blood Cancer 2015;62(8):1452-1460.
30. Gregory JW, Reilly JJ. Body Composition and Obesity. In: Wallace WH, Green DM (eds), Late Effects of Childhood Cancer. London, United Kingdom: Arnold, 2004. p. 147-61. .
31. Dickerman JD. The late effects of childhood cancer therapy. Pediatrics 2007;119:554-568.
32. Florin TA, Fryer GE, Miyoshi T, Weitzman M, Mertens AC, Hudson MM, et al. Physical inactivity in adult survivors of childhood acute lymphoblastic leukemia: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev 2007;16(7):1356-1363.
33. Stern M, Lamana L, Russell C, Edwin L, Thompson A, Trapp S, et al. Adaptation of an Obesity Intervention Program for Pediatric Cancer Survivors (NOURISH-T). Clin Pract Pediatr Psychology 2013;1(3):264-275.
34. Arroyave WD, Clipp EC, Miller PE, Jones LW, Ward DS, Bonner MJ, et al. Childhood cancer survivors’ perceived barriers to improving exercise and dietary behaviors. Oncol Nurs Forum 2008;35(1):121-130.
35. Ballal SA, Bechard LJ, Jaksic T. Nutritional Supportive Care. In Principles and Practice of Pediatric Oncology; Pizzo PA, Poplack DG, (eds), Wolters Kluwer Health/ Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2011. p. 1243-1255.
36. Bond SA, Han AM, Wootton SA, Kohler JA. Energy intake and basal metabolic rate during maintenance chemotherapy. Arch Dis Child 1992;67(2):229-232.
37. Delbecque-Boussard L, Gottrand F, Ategbo S, Nelken B, Mazingue F, Vic P, et al. Nutritional status of children with acute lymphoblastic leukemia: a longitudinal study. Am J Clin Nutr 1997;65:95-100.
38. Jansen H, Postma A, Stolk RP, Kamps WA. Acute lymphoblastic leukemia and obesity: increased energy intake or decreased physical activity? Support Care Cancer 2009;17:103-106.