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Changes in resting energy expenditure among children undergoing allogeneic stem cell transplantation^1,2,3

¹ From the Children’s Hospital, Boston (CD, LB, KD, AO, LL, and EG), and the Dana-Farber Cancer Institute, Boston (MV, CH, LL, and EG).

Background: Because of the effects of chemotherapy and radiotherapy, patients undergoing stem cell transplantation (SCT) are commonly provided nutritional support with parenteral nutrition. The energy and nutrient needs of these patients have not been well studied.

Objective: The objective was to measure resting energy expenditure (REE), dietary intake, and biochemical and anthropometric changes in children before and after allogeneic SCT.

Design: This was a prospective cohort study of 37 children aged 9.1 ± 6.4 y ( ± SD) undergoing SCT who were enrolled in an open-label trial of a unique supportive care intervention that included the routine use of oral leucovorin, vitamin E, and ursodeoxycholic acid. Parenteral nutrition was provided to match 100% of measured or estimated REE. REE was measured weekly via indirect calorimetry.

Results: Baseline REE was 95% of the predicted age- and sex-matched norms and was significantly correlated with midarm muscle area (r = 0.82, P < 0.001). REE fell to a nadir of 80% of the predicted levels by week 3 after SCT, with a gradual increase in weeks 4 and 5. Arm anthropometric measurements showed no change in triceps skinfold thickness but significant declines in midarm muscle area after SCT. Serum vitamin E remained in the normal range.

Conclusions: Children undergoing SCT show significant declines in REE after transplantation. These changes may be due to alterations in lean body mass. Standard nutritional regimens may lead to overfeeding.

Key Words: Energy expenditure • pediatrics • stem cell transplantation • supportive care

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