Arpe Marie-Louise Hyre, Rørvig Sascha, Kok Karin, Mølgaard Christian, Frandsen Thomas Leth
Pediatric Nutrition Unit, Copenhagen University Hospital, Rigshospitalet, Denmark.
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
Support Care Cancer. 2015 Dec;23(12):3573-80. doi: 10.1007/s00520-015-2718-5. Epub 2015 Apr 17.
Few studies have addressed the common issue of weight gain in children with acute lymphoblastic leukemia (ALL) during early phases of treatment, and even fewer have used the appropriate measure for weight fluctuation in children, BMI-for-age z-scores (BAZs). The purpose of this study is thus to measure the extent of the weight gain in BAZ during the 150 first days of treatment and to identify factors associated with the weight gain. Furthermore, we wish to raise the question of whether changes in treatment protocols automatically should be followed by an evaluation of the nutritional guidelines.
In this retrospective study, the medical records of 51 children with ALL treated with the NOPHO ALL 2008 protocol at Copenhagen University Hospital were assessed. Patient characteristics were extracted, and height, weight, and age during the first 150 days of treatment were converted to BAZ.
During 150 days of treatment, the proportion of overweight/obese patients increased significantly from 9.8 to 33.3 %. The mean change in BAZ (∆BAZ) was +1 standard deviation (0.02 ± 1.16 vs. 1.12 ± 1.44; p < 0.001) and BAZ increased significantly during periods with glucocorticoid (GC) treatment but not in periods without GC. ΔBAZ was larger in boys compared to girls, and ΔBAZ was higher in patients who were under/normal weight at diagnosis, compared to patients who were overweight/obese (1.26 ± 1.29 vs. -0.04 ± 0.41; p = 0.032).
BAZ increased significantly in children with ALL during the initial treatment with the NOPHO ALL 2008 protocol. This is likely associated with the GC administration and influenced by gender and initial BAZ.
很少有研究探讨急性淋巴细胞白血病（ALL）患儿在治疗早期体重增加这一常见问题，而且更少有人使用适合儿童体重波动的测量方法，即年龄别体重指数Z评分（BAZ）。因此，本研究的目的是测量治疗头150天内BAZ的体重增加程度，并确定与体重增加相关的因素。此外，我们希望提出一个问题，即治疗方案的改变是否应自动伴随营养指南的评估。
在这项回顾性研究中，对哥本哈根大学医院采用NOPHO ALL 2008方案治疗的51例ALL患儿的病历进行了评估。提取了患者特征，并将治疗头150天内的身高、体重和年龄转换为BAZ。
在150天的治疗期间，超重/肥胖患者的比例从9.8%显著增加到33.3%。BAZ的平均变化（∆BAZ）为+1个标准差（0.02±1.16对1.12±1.44；p<0.001），在糖皮质激素（GC）治疗期间BAZ显著增加，而在无GC治疗期间则没有增加。与女孩相比，男孩的∆BAZ更大；与超重/肥胖患者相比，诊断时体重不足/正常的患者的∆BAZ更高（1.26±1.29对-0.04±0.41；p=0.032）。
采用NOPHO ALL 2008方案初始治疗期间，ALL患儿的BAZ显著增加。这可能与GC给药有关，并受性别和初始BAZ的影响。
