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

Background: The nutrition status of haemopoietic stem cell transplant (HSCT) patients is often compromised as patients have increased energy and protein requirements and decreased intake of food due to side effects from related treatment. However, there are few studies on the nutritional status of such patients. Objective: The primary aim was to investigate the nutritional status of patients that are undergoing HSCT using a variety of anthropometric, biochemical, clinical and dietary parameters. The secondary aim was to investigate the food and nutrition experiences of these patients throughout treatment. Design: This was an observational pilot study undertaken at the bone marrow transplant unit (BMTU) of Christchurch Public Hospital that aimed to recruit 10 HSCT patients from pre-transplant (one month pre-HSCT) to post-transplant (two to three weeks post-HSCT). The following data was collected from patients: a three day weighed diet record (3DDR) at two time points (pre-HSCT and post-HSCT); patient generated - subjective global assessment (PG-SGA); anthropometric measures (weight, triceps skin folds (TSF), mid upper arm circumference (MUAC)); and blood tests (Vitamin E, C, D, Folate, pre-albumin). Clinical data was also obtained from medical records. A semi- structured qualitative interview was undertaken when the patient was discharged to obtain information about food and nutrition experiences during treatment. Results: Eight patients undergoing autologous HSCT participated in the study. Energy and protein intakes decreased post-HSCT; mean ± S.D energy intake decreased from 10,825 ± 2308 kJ/day to 5,306 ± 3525 kJ/day and protein intake decreased from 122 ± 58 g/day to 47 ± 40 g/day. Weight, BMI and TSF did not change throughout the study period. Percentage Weight Loss (PWL) increased from a mean ± S.D loss of 1.9 ± 3.3 % at day +7 to 2.7 ± 5.6 % at day +14. There were small decreases in MUAC and MAMC from 31.1 ± 5.0mm to 30.0 ± 5.0 and 26.9 ± 4.7mm to 25.73 ± 5.0mm, respectively. Blood indices of Vitamin E, C, D, Folate and pre-albumin decreased pre-HSCT to post- HSCT. However, all remained within the normal reference range for that nutrient, with the exception of Vitamin D (measured as 25-hydroxyvitamin D) which was below the reference range (50-150 nmol/L) pre (44.3 ± 13.6 nmol/L) and post-HSCT (37.6 ± 8.9 nmol/L). Albumin decreased and CRP increased to above the reference range from pre- HSCT to post-HSCT. PG-SGA score increased from 3 pre-HSCT to >9 post-HSCT in all participants. Nausea, vomiting and diarrhoea were the most commonly reported symptoms experienced. Patients also reported these symptoms as a barrier to intake, as well as hospital food not meeting personal preferences. Conclusion: The nutritional status of these patients was compromised throughout the HSCT procedure demonstrated by a decrease in energy and protein intake, PWL and patients commonly presenting with side effects affecting the ability to consume food. As nutrition status is positively correlated with the outcome of HSCT, these results highlight the importance of assessment and intervention in HSCT patients, which could improve the likelihood of a positive outcome