Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical nutrition, enteral and parenteral nutrition

Survival in overweight and underweight children undergoing hematopoietic stem cell transplantation

Abstract

Background/objectives:

There is a growing body of evidence that nutritional status influences the morbidity and mortality of children undergoing treatment for cancer. The aim of this paper is to determine if nutritional status is associated with survival post-pediatric bone marrow transplant.

Subjects/methods:

This was a single-center retrospective audit of patients who underwent an autologous or allogeneic hematopoietic stem cell transplant. Patients were divided into three weight categories of underweight, ideal weight and overweight defined by percent ideal body weight. The outcome of interest, overall post transplant survival, was compared between weight categories.

Results:

Of 113 patients, 15 (13%) were underweight and 41 (36%) were classified as overweight. After adjustment for age, sex, donor source, conditioning therapy and year of transplant, overweight patients were significantly less likely to survive than ideal-weight patients (hazard ratio (HR) 1.91; 95% confidence interval, 1.10–3.31). There was no significant increase in mortality when underweight patients were compared with ideal-weight patients (HR 1.47; 95% confidence interval, 0.57–3.79).

Conclusions:

Children who are overweight before hematopoietic stem cell transplantation have decreased survival compared with ideal-weight children.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Ladas ED, Sacks N, Brophy P, Rogers PC . Standards of nutritional care in pediatric oncology. Pediatr Blood Cancer 2006; 46: 339–344.

    Article  Google Scholar 

  2. Donaldson SS, Wesley MN, DeWys WD, Suskind RM, Jaffe N, vanEys J . A study of the nutritional status of pediatric cancer patients. Am J Dis Child 1981; 135: 1107–1112.

    CAS  PubMed  Google Scholar 

  3. Rogers PC, Meacham LR, Oeffinger KC, Henry DW, Lange BJ . Obesity in pediatric oncology. Pediatr Blood Cancer 2005; 45: 881–891.

    Article  Google Scholar 

  4. Lange BJ, Gerbing RB, Feusner J, Skolnik J, Sacks N, Smith F et al. Mortality in overweight and underweight children with acute myeloid leukemia. JAMA 2005; 293: 203–211.

    Article  CAS  Google Scholar 

  5. Butturini AM, Dorey FJ, Lange BJ, Gaynon PS, Fu C, Franklin J et al. Obesity and outcome in pediatric acute lymphoblastic leukemia. J Clin Oncol 2007; 25: 2063–2069.

    Article  Google Scholar 

  6. Withycombe JS, Post-White JE, Mezza JL, Hawks RG, Smith LM, Sacks N et al. Weight patterns in children with higher risk ALL: a report from the children’s oncology group (COG) for CCG 1961. Pediatr Blood Cancer 2009; 53: 1249–1254.

    Article  Google Scholar 

  7. Woods W, Neudorf S, Gold S, Sanders J, JD Buckley, Barnard DR et al. A comparison of allogeneic bone marrow transplantation, autologous bone marrow transplantation, and aggressive chemotherapy in children with acute myeloid leukemia in remission: a repost from the Children’s Cancer Group. Blood 2001; 97: 56–62.

    Article  CAS  Google Scholar 

  8. Robin M, Guardiola P, Dombret H, Baruchel A, Esperou H, Ribaud P et al. Allogeneic bone marrow transplantation for acute myeloblastic leukaemia in remission: risk factors for long term morbidity and mortality. Bone Marrow Transplant 2003; 31: 877–887.

    Article  CAS  Google Scholar 

  9. Woolfrey AE, Anasetti C, Storer B, Doney K, Milner LA, Sievers EL et al. Factors associated with outcome after unrelated marrow transplantation for treatment of acute lymphoblastic leukemia in children. Blood 2002; 99: 2002–2008.

    Article  CAS  Google Scholar 

  10. White MS, Murphy A, Hastings Y, Shergold J, Lockwood L . Energy expenditure and body composition in children pre-bone marrow transplant. Bone Marrow Transplant 2005; 35: 775–779.

    Article  CAS  Google Scholar 

  11. Hopman GD, Pena EG, Le Cessie S, Van Weel MH, Vossen JM, Mearin ML . Tube feeding and bone marrow transplantation. Med Pediatr Oncol 2003; 40: 375–379.

    Article  CAS  Google Scholar 

  12. Muscaritoli M, Grieco G, Capria S, Iori AP, Rossi Fanelli F . Nutritional and metabolic support in patients undergoing bone marrow transplantation. Am J Clin Nutr 2002; 75: 183–190.

    Article  CAS  Google Scholar 

  13. Centers for Disease Control and Prevention. Growth Charts. Developed by the National Center for Health Statistics in Collaboration with the National Centre for Chronic Disease Prevention and Health Promotion 2000 Available at: http://www.cdc.gov/growthcharts.

  14. Elliott L, Molseed LL, McCallum P eds. The Clinical Guide to Oncology Nutrition. 2nd edn Oncology Nutrition Dietetic Group, The American Dietetic Association: Chicago, Illinois, 2006.

    Google Scholar 

  15. Rogers PC, Melnick SJ, Ladas EJ, Halton J, Baillargeon J, Sacks N . Children’s Oncology Group (COG) Nutrition Committee. Pediatr Blood Cancer 2008; 50: 447–450.

    Article  Google Scholar 

  16. Fleming DR, Rayens MK, Garrison J . Impact of obesity on allogeneic stem cell transplant patients: a matched case controlled study. Am J Med 1997; 102: 265–268.

    Article  CAS  Google Scholar 

  17. Dickson TM, Kushiwerz-Glaz CR, Blume KG, Negrin RS, Hu WW, Shizuru JA et al. Impact of admission body weight and chemotherapy dose adjustment on the outcome of autologous bone marrow transplantation. Biol Blood Marrow Transplant 1999; 5: 299–305.

    Article  CAS  Google Scholar 

  18. Meloni G, Proia A, Capria S, Romano A, Trapé G, Trisolini SM et al. Obesity and autologous stem cell transplantation in acute myeloid leukemia. Bone Marrow Transplant 2001; 28: 365–367.

    Article  CAS  Google Scholar 

  19. Gibbs JP, Gooley T, Coreau B, Murray G, Stewart P, Appelbaum FR et al. The impact of obesity and disease on busulfan oral clearance in adults. Blood 1999; 93: 4436–4440.

    CAS  PubMed  Google Scholar 

  20. Onuma M, Bub JD, Rummel TL, Iwamoto Y . Prostate cancer cell-adipocyte interaction: leptin mediates androgen0independent prostate cancer cell proliferation through c-Jun NH2-terminal kinase. J Biol Chem 2003; 278: 42660–42667.

    Article  CAS  Google Scholar 

  21. Ladas EJ, Sacks N, Meacham L, Henry D, Enriquez L, Lowry G et al. A multidisciplinary review of nutrition considerations in the pediatric oncology population: a perspective from children’s oncology group. Nutr Clin Prac 2005; 20: 377–393.

    Article  Google Scholar 

  22. Australian Government, Department of Health and Ageing. Australian national children’s nutrition and physical activity survey, 2007.

  23. White MS, Davies PSW, Murphy AJ . Validation of percent body fat indicators in pediatric oncology nutrition assessment. J Pediatr Hematol Oncol 2008; 30: 124–129.

    Article  Google Scholar 

  24. Murphy AJ, White M, Davies PS . Body composition of children with cancer. Am J Clin Nutr 2010; 92: 55–60.

    Article  CAS  Google Scholar 

  25. Van Eys J . Malnutrition in children with cancer: incidence and consequence. Cancer 1979; 43 (5 suppl), 2030–2035.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the Children’s Nutrition Research Centre, School of Medicine, The University of Queensland, Nutrition and Dietetics Department and the Queensland Children’s Cancer Centre and the Queensland Children’s Institute of Medical Research, The University of Queensland.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M White.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

White, M., Murphy, A., Hallahan, A. et al. Survival in overweight and underweight children undergoing hematopoietic stem cell transplantation. Eur J Clin Nutr 66, 1120–1123 (2012). https://doi.org/10.1038/ejcn.2012.109

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2012.109

Keywords

This article is cited by

Search

Quick links