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

European Journal of Clinical Nutrition (2024)Cite this article

Subjects

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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Data availability

Data analyzed in this study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank the Departments of Dietetics and Nutrition, the Departments of Physiotherapy and the Hematology Departments of the following hospitals for their participation in the current study: Albert Schweitzer Hospital, Dordrecht; Maxima MC, Veldhoven; Meander Medical Center, Amersfoort; and Sint Antonius Hospital, Nieuwegein. Furthermore, we thank Mara Lam, Aniek Schuurbiers, Mandy van Gils, Laura Boots, Dana Verhoeven and Eske Ruijters for their help in reviewing and entering the data.

Funding

This work was partially supported by the Vrienden Integrale Oncologische Zorg Foundation, Utrecht, The Netherlands (2017); Baxter B.V., Utrecht, The Netherlands (GHOL6759, 2018); Fresenius Kabi Nederland B.V., Huis ter Heide, The Netherlands (2019), Albert Schweitzer Hospital’s Research Fund, Dordrecht, The Netherlands (2019). These funding sources did not play any role in the design of the study, the collection, analysis and interpretation of data, in writing of the report nor in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Dietetics and Nutrition, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands

    Rianne van Lieshout & Debbie van der Lee

  2. Department of Internal Medicine, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands

    Lidwine W. Tick

  3. Department of Internal Medicine, Division Hematology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Erik A. M. Beckers & Harry C. Schouten

  4. Department of Dietetics and Nutrition, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands

    Willemijn Biesbroek

  5. Department of Research, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands

    Jeanne P. Dieleman

  6. Department of Physiotherapy, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands

    Myrthe Dijkstra

  7. Department of Physiotherapy, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands

    Wanda Groenesteijn

  8. Department of Internal Medicine, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands

    Harry R. Koene

  9. Department of Dietetics and Nutrition, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands

    Suzanne Kranenburg & Liesbeth van der Put - van den Berg

  10. Department of Physiotherapy, Maxima MC, De Run 4600, 5504 DB, Veldhoven, The Netherlands

    Nicky Rademakers

  11. Department of Internal Medicine, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands

    Josien C. Regelink

  12. Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands

    Claudia J. van Tilborg, Peter E. Westerweel & Sandra de Zeeuw

  13. Department of Research and Development, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands

    Sandra Beijer

  14. Department of Dietetics and Nutrition, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Sandra Beijer

Authors
  1. Rianne van Lieshout
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  2. Lidwine W. Tick
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  3. Erik A. M. Beckers
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  4. Willemijn Biesbroek
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  5. Jeanne P. Dieleman
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  6. Myrthe Dijkstra
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  7. Wanda Groenesteijn
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  8. Harry R. Koene
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  9. Suzanne Kranenburg
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  17. Harry C. Schouten
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  18. Sandra Beijer
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Contributions

Rianne van Lieshout contributed to the conception of the study. Rianne van Lieshout and Sandra Beijer contributed to the design of the study. Rianne van Lieshout, Willemijn Biesbroek, Wanda Groenesteijn, Suzanne Kranenburg, Debbie van der Lee, Liesbeth van der Put, Nicky Rademakers, Claudia J. van Tilborg and Sandra de Zeeuw contributed to the acquisition of the data. Analysis of the data was performed by Rianne van Lieshout. Rianne van Lieshout, Lidwine W. Tick, Prof. Erik A.M. Beckers, Jeanne P. Dieleman, Harry R. Koene, Josien C. Regelink, Peter E. Westerweel, Em. Prof. Harry C. Schouten and Sandra Beijer contributed to the interpretation of the data. Rianne van Lieshout drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version to be submitted.

Corresponding author

Correspondence to Rianne van Lieshout.

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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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van Lieshout, R., Tick, L.W., Beckers, E.A.M. et al. Changes in nutritional status and associations with physical and clinical outcomes in acute myeloid leukemia patients during intensive chemotherapy. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01488-8

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