A Pilot Study of the Nutritional Status of Patients Undergoing Haemopoietic Stem Cell Transplantation

Abstract

Background: The nutritional status of patients undergoing haemopoietic stem cell transplants (HSCT) is often compromised as patients have increased energy and protein requirements, and often experience adverse side effects from treatment (nausea, vomiting, diarrhoea, taste changes and mucositis) affecting dietary intake. The current research available frequently reports compromised nutritional status in HSCT patients, however few of these studies have measured diet, an essential component of nutritional assessment.

Objective: The primary aim of this study was to investigate the nutritional status of patients undergoing HSCT using dietary, anthropometric, biochemical and clinical measures. The secondary aim was to investigate the food and nutrition experiences of HSCT patients over their inpatient stay in hospital. Design: This was an observational pilot study based in the bone marrow transplant unit (BMTU) at Christchurch Hospital. The study aimed to recruit 10 participants to be followed from pre-assessment (one month prior to HSCT) until discharge from hospital (two to three weeks post-HSCT). Participants were required to complete three-day weighed diet records, patient guided-subjective global assessment (PG-SGA), anthropometric measures (BMI, percentage weight loss (PWL), mid-upper arm circumference (MUAC) and triceps skinfold (TSF)), twenty-four hour urine collections (iodine, creatinine, potassium and sodium), and blood tests (vitamin E, C, D, folate, selenium, zinc and pre-albumin) on two occasions (pre-HSCT and post-HSCT). Corresponding clinical data was collected from nurses and patient notes. Results: Eight participants over 18 years of age, who underwent a planned autologous-HSCT completed the study. From pre-HSCT to post-HSCT, there was a decrease in energy (9051 ± 2662 kJ/day to 3330 ± 1337 kJ/day; p<0.01) and protein intake (89 ± 26 g/day to 35 ± 20 g/day; p<0.01). Post-HSCT, dietary macronutrient and micronutrient intakes were no longer meeting EAR, RDI, AMDR or BMT recommendations, except for vitamin C. One week post-HSCT, PWL was 4.1 ± 1.2%, indicating severe weight loss (>2%). No change was seen in MUAC and TSF post-HSCT. There was a decrease in the blood indices vitamin E, C, D and folate, but these still fell within the normal reference range. Albumin and pre-albumin decreased below the normal reference ranges, and CRP increased above the normal reference range. Urinary sodium increased from pre-HSCT to post-HSCT (92 ± 30 to 194 ± 96 mmol/day; p=0.034), but this still fell within the normal reference range (100-250 mmol/day). The PG-SGA scores increased from 3 to 20, and the most common reported symptoms were nausea (100%), vomiting (87.5%) and diarrhoea (87.5%). In the interview, these adverse symptoms (nausea, vomiting and diarrhoea) were reported as the main barrier to food intake, in addition to disliking hospital food. Conclusion: This pilot study found the nutritional status of HSCT patients was compromised post-HSCT shown by decreased dietary intakes, weight loss and the presence of treatment-related symptoms highlighting the importance for structured follow-up of HSCT patients post-discharge. Further research is required on the nutritional status of HSCT patients.