Falcone Luca, Mancin Stefano, Azzolini Elena, Colotta Francesco, Ferrante Sergio, Pastore Manuela, Morales Palomares Sara, Lopane Diego, Sguanci Marco, Cosmai Simone, Cattani Daniela, Cereda Emanuele, Caccialanza Riccardo, Mazzoleni Beatrice
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy.
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
Nutrients. 2024 Dec 20;16(24):4387. doi: 10.3390/nu16244387.
Nutritional interventions play a critical role in bone marrow transplant (BMT) patients. This review evaluates the effectiveness of nutritional strategies in mitigating post-transplant malnutrition and improving clinical outcomes.
A systematic review was conducted using PubMed, CINAHL, Cochrane Library, and Embase. The search terms included "bone marrow transplant", "malnutrition", and "preoperative nutritional interventions". The quality of studies and risk of bias were assessed using the JBI framework, while evidence certainty was evaluated with the Oxford OCEBM.
Six studies were included (n = 3545 screened). The studies demonstrated predominantly high methodological quality and a low risk of bias, although heterogeneity in the treatments investigated and small sample sizes limited the evidence. Nutritional interventions significantly increased energy intake (26 vs. 24 kcal/kg/day, = 0.038) and improved body weight (25% vs. 9%) with protein supplementation. Clinical complications decreased, including severe acute graft-versus-host disease (17.1% vs. 43.4%, = 0.001) and pneumonia (27.6% vs. 52.7%, = 0.002). The length of hospital stay (27 vs. 32 days, = 0.006) and the need for parenteral nutrition (53% vs. 62%, = 0.03) were also reduced. Overall survival improved with ≥50% adherence to prescribed TGF-beta2 intake (33 vs. 25.1 months, = 0.03).
Nutritional prehabilitation shows promise in improving BMT outcomes. Standardized nutritional programs could optimize care, although limitations in current evidence are clearly present. Larger randomized studies are needed to confirm findings and refine pre-transplant protocols.
营养干预在骨髓移植（BMT）患者中起着关键作用。本综述评估了营养策略在减轻移植后营养不良和改善临床结局方面的有效性。
使用PubMed、CINAHL、Cochrane图书馆和Embase进行系统综述。检索词包括“骨髓移植”、“营养不良”和“术前营养干预”。使用JBI框架评估研究质量和偏倚风险，同时用牛津循证医学中心（OCEBM）评估证据确定性。
纳入六项研究（共筛查3545例）。尽管所研究的治疗方法存在异质性且样本量较小限制了证据，但这些研究总体上显示出较高的方法学质量和较低的偏倚风险。营养干预显著增加了能量摄入（26千卡/千克/天对24千卡/千克/天，P = 0.038），并通过补充蛋白质改善了体重（25%对9%）。临床并发症减少，包括严重急性移植物抗宿主病（17.1%对43.4%，P = 0.001）和肺炎（27.6%对52.7%，P = 0.002）。住院时间（27天对32天，P = 0.006）和肠外营养需求（53%对62%，P = 0.03）也有所减少。≥50%依从规定的转化生长因子-β2摄入量可改善总生存期（33个月对25.1个月，P = 0.03）。
营养预康复在改善BMT结局方面显示出前景。标准化营养方案可优化护理，尽管目前证据存在明显局限性。需要更大规模的随机研究来证实研究结果并完善移植前方案。
