Body Composition, Bone Health, and Dietary Intake in Children After Allogeneic Hematopoietic Stem Cell Transplantation.

Background/

Objectives

This study describes body composition, bone mineral density (BMD), and dietary intake in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation compared to healthy children.

Methods

In this prospective observational study, dual-energy X-ray absorptiometry was used to assess appendicular lean mass index (ALMI), fat mass index (FMI), fat mass percentage (FM%), and BMD, and a 4-day dietary record was used to assess dietary intake at 3 months and 1 year post-transplant. Healthy children were assessed once by the same methods.

Results

We included 28 patients (mean 10.3 years, SD 4.0) and 50 healthy children (mean 10.0 years, SD 3.6). At 1 year, median Z-scores were lower for ALMI (-1.34 vs. 0.40, p < 0.001), higher for FMI (0.34 vs. -0.33, p < 0.012) and FM% (0.59 vs. -0.98, p < 0.001), lower for BMD total body less head (-1.0 vs. 0.3, p = 0.006), but similar for BMD spine compared to healthy children. At 1 year, 9/15 (60%) had ALMI Z-score ≤ -1, 6/15 (40%) had FMI Z-score ≥ 1, 5/15 (33%) had FM% Z-score ≥ 1, and 8/18 (53%) had BMD total body less head Z-score ≤ -1, and 3/15 (20%) had BMD spine Z-score ≤ -1. Dietary intake improved, and at 1 year, energy and protein intakes were comparable, fat, calcium, and vitamin D intakes were higher, but fiber intake remained lower in patients than in healthy children.

Conclusions

Patients had a more unfavorable body composition and bone health. Dietary intake improved from 3 months to 1 year post-transplant. However, the results indicate a need for nutritional follow-up, particularly targeting protein, fat, fiber, calcium, and vitamin D.