Abstract:

Objective To investigate influencing factors of dietary changes in children undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT) and to analyze the correlation between reduced dietary intakes and clinical outcomes during hospitalization. Methods We collected data of 144 children undergoing alloHSCT from hospital between April 2018 and August 2023. Dietary intakes and nutritional status were assessed prior to transplantation and on day 0, +14 and +30 after alloHSCT. The relationship between post-transplant clinical outcomes and dietary intakes was analyzed using Spearman correlation analysis. Results The baseline energy intake was 1315.20 (922.15-1600.88) kcal/d, representing 90.85% (80.10%-103.00%) of the dietary reference intakes (DRIs). On day 0, +14 of transplantation, the calorie intake decreased to 344.95 (66.85-532.50) kcal/d and 377.90 (108.43-689.40) kcal/d, the percentage of dietary caloric intake in DRIs decreased to 25.50% (4.20%-46.25%) and 23.50% (7.21%-50.08%), respectively. The intake of macronutrient also significantly decreased. By day +30 post-transplantation, dietary intake and macronutrient increased, with dietary intake increased to 721.45 (285.75-1252.25) kcal/d, accounting for 58.00% (21.50%-81.92%) of DRIs (P<0.001 ). The generalized estimation equation analysis showed that age (P<0.001), oral mucositis (P=0.023), Ⅱ-Ⅳ acute graft versus host disease (aGVHD, P<0.001), length of cumulative febrile episodes (P=0.005), and a high risk of STAMP before transplantation (P=0.026) were significant influencing factors for changes in dietary intake. The negative correlation between dietary intake of children undergoing alloHSCT and decrease in BMI-Z, length of hospital stay, and inpatient treatment costs was observed, with r values of (-0.516, -0.238, -0.465) and P values of (<0.001, 0.011, <0.001) respectively. Conclusion After alloHSCT, dietary intake and macronutrient of children with varying nutritional status, disease diagnosis, and transplant types significantly decreased. This reduction in dietary intake was associated with adverse clinical outcomes. Attention should be given to the changes in dietary intake and macronutrient in all children post-transplantation, especially for those of older age, high risk of STAMP, or with oral mucositis, Ⅱ-Ⅳ grade aGVHD, and severe infection. Timely and effective nutritional interventions are essential.

Key words: allogeneic hematopoietic stem cell transplantation, dietary analysis, nutritional risk screening, malnutrition