NUTRITIONAL-STATUS OF CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA - A LONGITUDINAL-STUDY

To evaluate the nutritional consequences of acute lymphoblastic leukem ia and its treatment, 15 children with leukemia were studied. Anthropo metric data, fat-free mass by impedance, energy intake, and resting en ergy expenditure (REE) were determined at diagnosis and on days 22, 36 , and 71 of the treatment. Interleukin (IL)-1 beta, IL-6, interferon-g amma, and tumor necrosis factor were also measured. Fifteen healthy co ntrol subjects were matched for age and sex. Body weight and height an d body composition were comparable at all times of the study, although three children were underweight at diagnosis (weight-for-height < 85% of French standards). Although two different methods were used for di etary recall in the two groups, energy intake expressed as a percentag e of normal recommended values for age and sex was lower in patients t han in control subjects (104 +/- 19%) on day 1 (47 +/- 32.1%) and day 22 (58 +/- 24%), but was comparable on day 36 (85 +/- 71%) and day 71 (85 +/- 48%). This low energy intake involved both carbohydrates and f ats. Energy and carbohydrate intakes improved significantly during the study in patients. The nonprotein respiratory quotient (RQ) in patien ts was significantly lower than in control subjects (0.84 +/- 0.04) on day 1 (0.79 +/- 0.02) but was comparable on day 71. The REE of the pa tients on day 1 (5057.8 +/- 1588.4 kJ/24 h) and day 71 (4844.7 +/- 116 .1 kJ/24 h) and of the control subjects (4313.8 +/- 823.5 kJ/24 h) was not significantly different. Cytokines remained undetectable on days 1, 36, and 71. The results showed that at the time of diagnosis and du ring this period of chemotherapy there was no evidence of raised REE. The poor intakes during the first month of chemotherapy were recent as shown by the parents' questionnaire responses and the absence of cons equences in body composition. The transient decrease in RQ seemed to b e an adaptative mechanism to the poor carbohydrate intake. No indicati on of undernutrition in the patients as a group was evident during the first 71 d of treatment although further long-term nutritional assess ment is needed.