Early Nutrition Intervention Attenuates Weight Gain for Pediatric Acute Lymphoblastic Leukemia Patients in Maintenance Therapy

Early Nutrition Intervention Attenuates Weight Gain for Pediatric Acute Lymphoblastic Leukemia Patients in Maintenance Therapy
Children with ALL are at increased risk for long-term obesity. Recent studies have indicated that weight gain begins during ALL therapy, particularly during induction and maintenance phases, and often persists beyond treatment. There are no published strategies specific to the pediatric ALL population to reduce obesity.
In a retrospective manner, this study investigated the impact of a 3-visit nutrition intervention early in maintenance therapy involving 3 one-on-one visits with a registered dietician. The visits focused on the child's current nutritional status and goals and provided handouts. 33 patients who received the intervention were compared with a control group of 34 historical patients. BMI was recorded at diagnosis, end of induction, beginning of delayed intensification, day 1 of maintenance therapy and monthly for 12 months.
As expected, the mean BMI z-score increased from diagnosis to day 29 of induction, dropped in delayed intensification and then rose throughout maintenance therapy. There was no statistically significant difference between the BMI z-score of the control group and the intervention group at the different time points. On multivariate analysis, the intervention group's BMI z-scores increased less over maintenance therapy compared to the control group (P=0.0001). However, the intervention was less effective for patients who gained more in BMI z-scores between diagnosis and the start of maintenance therapy.
Information on behaviours including diet and exercise and other indicators of body composition including fat composition were not collected as it was a retrospective chart study. The patients who received the intervention was at the discretion of their health care team. The small sample size, potential selection bias, and use of a historical control severely limits the generalizability of the results.
This study does not provide evidence for efficacy of this particular intervention but does not mean that educational interventions are not useful. Future prospective trials should be well designed and draw from the extensive experience in the adult literature.

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