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Pediatric Transplants

Attenuation of resting energy expenditure following hematopoietic SCT in children

Bone Marrow Transplantation volume 47, pages 1301–1306 (2012)Cite this article

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Abstract

Children undergoing hematopoietic SCT (HSCT) typically receive parenteral nutrition (PN) due to gastrointestinal toxicities. Accurate determination of resting energy expenditure (REE) may facilitate optimal energy provision and help avoid unintended overfeeding or underfeeding. A multicenter, prospective cohort study of children undergoing allogeneic HSCT was performed, in which REE was measured by indirect calorimetry at baseline and twice weekly until 30 days after transplantation. Change in percent predicted REE over time from admission was analyzed using repeated measures regression analysis. In all, 26 children (14 females) with a mean (s.d.) age of 14.9 (4.2) years who underwent an HLA-matched sibling or unrelated donor transplantation were enrolled. Mean (s.d.) percent predicted REE at baseline was 92.4 (15.2). Baseline REE was highly correlated with lean body mass measured by dual energy X-ray absorptiometry (r=0.78, P<0.0001). REE decreased significantly over time, following a quadratic curve to a nadir of 79% predicted at 14 days post transplantation (P<0.001) and returned to near baseline by day 30. Children undergoing HSCT exhibit a significant reduction in REE in the early weeks after transplantation, a phenomenon that places them at risk for overfeeding. Serial measurements of REE or reductions in energy intake should be considered when PN is the primary mode of nutrition.

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Acknowledgements

We appreciate the dedication and support of all the participants, and the helpful assistance of Nicolle Quinn, MS, RD, LDN and Patricia Jardack, MS, RD. This project was supported by the Massachusetts Vitamin Litigation Grant; grant M01-RR02172 from the NCRR, the NIH to Children's Hospital, Boston GCRC; grant UL1 RR025758-01 to the Harvard Catalyst CTSA 1; grant M01-RR00865 to the General Clinical Research Centers Program at UCLA; and NIH K24 HD 058795 (CD).

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Authors and Affiliations

  1. Children's Hospital Boston, Boston, MA, USA

    L J Bechard, H A Feldman, K Gura, C Gordon, A Sonis, N Mehta, E C Guinan & C Duggan

  2. Dana-Farber Cancer Institute, Boston, MA, USA

    L J Bechard & E C Guinan

  3. UCLA Mattel Children's Hospital, Los Angeles, CA, USA

    R Venick

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  1. L J Bechard
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Correspondence to L J Bechard.

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Bechard, L., Feldman, H., Venick, R. et al. Attenuation of resting energy expenditure following hematopoietic SCT in children. Bone Marrow Transplant 47, 1301–1306 (2012). https://doi.org/10.1038/bmt.2012.19

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