Warris Lidewij T, van den Akker Erica L T, Bierings Marc B, van den Bos Cor, Aarsen Femke K, Zwaan Michel C, Tissing Wim J E, Veening Margreet A, Pieters Rob, van den Heuvel-Eibrink Marry M
Department of Pediatric Oncology, Erasmus MC Cancer Institute, Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Pediatric Endocrinology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Pediatr Blood Cancer. 2017 Dec;64(12). doi: 10.1002/pbc.26679. Epub 2017 Jun 9.
Large prospective studies on dexamethasone-induced changes in eating behavior, energy, and nutrient intake are lacking in pediatric acute lymphoblastic leukemia (ALL). We prospectively studied eating behavior, energy, nutrient intake, and the effect on leptin and adiponectin levels during dexamethasone administration in children with ALL.
Parents of patients with ALL (3-16 years) completed a dietary diary for their child during 4 days of dexamethasone (6 mg/m ) administration. Energy intake and nutrient intake (energy percentage = E%) were assessed and compared with the recommended intake. The Dutch Eating Behavior Questionnaire for Children was completed before start and after 4 days of dexamethasone administration by patients of 7-12 years of age. Fasting leptin and adiponectin levels were also measured before start and after 4 days of dexamethasone administration.
Energy intake per day(kcal) (N = 44) increased significantly during dexamethasone (median day 1: 1,103 (717-1,572) versus day 4: 1,482 (1,176-1,822), P < 0.01), including an increase in total protein, fat, saturated fat, carbohydrate, and sodium intake. Intake of saturated fat (median day 4: 12 E%) and salt (median day 4: 1.9 g/day) exceeded the healthy range for age and gender. With respect to eating behavior, dexamethasone significantly decreased restrained eating (P = 0.04). Leptin levels as well as adiponectin levels increased significantly during the dexamethasone course.
Four days of dexamethasone treatment significantly increased energy intake, including excessive saturated fat and salt intake, and changed eating behavior in children with ALL. Nutritional and behavioral interventions during dexamethasone treatment are recommended to stimulate a healthy lifestyle.
目前缺乏关于地塞米松对小儿急性淋巴细胞白血病（ALL）患者饮食行为、能量及营养摄入影响的大型前瞻性研究。我们前瞻性地研究了ALL患儿在地塞米松给药期间的饮食行为、能量、营养摄入以及对瘦素和脂联素水平的影响。
ALL患儿（3 - 16岁）的家长在患儿接受地塞米松（6 mg/m²）治疗的4天内完成了一份饮食日记。评估了能量摄入和营养摄入（能量百分比 = E%），并与推荐摄入量进行比较。7 - 12岁的患儿在开始服用地塞米松前及服药4天后完成了荷兰儿童饮食行为问卷。在开始服用地塞米松前及服药4天后还测量了空腹瘦素和脂联素水平。
地塞米松治疗期间，每日能量摄入量（千卡）（N = 44）显著增加（第1天中位数：1,103（717 - 1,572）对比第4天：1,482（1,176 - 1,822），P < 0.01），包括总蛋白、脂肪、饱和脂肪、碳水化合物和钠摄入量的增加。饱和脂肪摄入量（第4天中位数：12 E%）和盐摄入量（第4天中位数：1.9克/天）超过了年龄和性别的健康范围。关于饮食行为，地塞米松显著降低了饮食节制（P = 0.04）。在地塞米松治疗过程中，瘦素水平和脂联素水平均显著升高。
地塞米松治疗4天显著增加了ALL患儿的能量摄入，包括饱和脂肪和盐的过量摄入，并改变了饮食行为。建议在地塞米松治疗期间进行营养和行为干预，以促进健康的生活方式。
