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Observational Study
. 2024 Dec;78(12):1082-1094.
doi: 10.1038/s41430-024-01488-8. Epub 2024 Aug 10.

Changes in nutritional status and associations with physical and clinical outcomes in acute myeloid leukemia patients during intensive chemotherapy

Rianne van Lieshout  1 , Lidwine W Tick  2 , Erik A M Beckers  3 , Willemijn Biesbroek  4 , Jeanne P Dieleman  5 , Myrthe Dijkstra  6 , Wanda Groenesteijn  7 , Harry R Koene  8 , Suzanne Kranenburg  9 , Debbie van der Lee  10 , Liesbeth van der Put-van den Berg  9 , Nicky Rademakers  11 , Josien C Regelink  12 , Claudia J van Tilborg  13 , Peter E Westerweel  13 , Sandra de Zeeuw  13 , Harry C Schouten  3 , Sandra Beijer  14   15
Affiliations
Observational Study

Changes in nutritional status and associations with physical and clinical outcomes in acute myeloid leukemia patients during intensive chemotherapy

Rianne van Lieshout et al. Eur J Clin Nutr. 2024 Dec.

Abstract

Background/objectives: Patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) often receive medical nutrition therapy (MNT) during intensive remission-induction treatment. Since little is known about changes in nutritional status, specifically body composition, in this patient population, these changes and their associations with physical and clinical outcomes were assessed.

Subjects/methods: In this multicenter prospective observational study, newly diagnosed AML/MDS patients who received intensive remission-induction chemotherapy, routine dietary counseling by a dietician and MNT immediately upon inadequate nutritional intake, were included. At treatment initiation and discharge, nutritional status, including Patient-Generated Subjective Global Assessment (PG-SGA)-scores and body composition, physical outcomes and fatigue were assessed. Associations of nutritional status/body composition with physical outcomes, fatigue, fever duration, number of complications, time to neutrophil engraftment and hospital length of stay (LOS) (collected from medical records) were examined using multiple regression analysis.

Results: In >91% of the 126 AML/MDS patients included, nutritional intake was adequate, with 61% receiving MNT. Nevertheless, body weight decreased significantly (p < 0.001) and mainly consisted of a loss of muscle/fat-free mass (FFM) (p < 0.001), while fat mass (FM) remained unchanged (p-value range = 0.71-0.77). Body weight and waist circumference showed significant negative associations with fever duration and/or number of complications. Significant positive associations were found between mid-upper arm muscle circumference (MUAMC) and physical functioning and between PG-SGA-scores and fatigue. Body weight and MUAMC were also negatively associated with LOS.

Conclusion: Despite MNT in AML/MDS patients undergoing intensive chemotherapy, muscle/FFM decreased while FM remained unchanged. Maintenance of nutritional status was associated with improved physical and clinical outcomes.

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Conflict of interest statement

Competing interests: RvL has received unrestricted research grants from the Vrienden Integrale Oncologische Zorg Foundation, Utrecht, The Netherlands, Baxter B.V. Utrecht, The Netherlands (Grand reference number: GHOL6759) (Category 1), and Fresenius Kabi Nederland B.V., Huis ter Heide, The Netherlands (Category 1). C.J.v.T., S.d.Z. and P.E.W. have received an unrestricted research grant from the Albert Schweitzer Hospital’s Research Fund, Dordrecht, The Netherlands. The other authors have nothing to disclose. Ethical approval: The study protocol was reviewed and exempted from ethics approval by the Medical Ethics Committee Maxima MC (N17025). The study procedures were in accordance with the rules of the European Personal Data Protection Act and the Code of Ethics of the World Medical Association (Helsinki Declaration). The study was registered at The Dutch Trial Register (NTR) with trial number NL8505. Written informed consent was obtained from all patients prior to enrollment in the study.

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