A bilingual dietary intervention early in treatment is feasible and prevents weight gain in childhood acute lymphoblastic leukemia

Abstract

Background Childhood acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. The onset of obesity during childhood ALL has been well established and is associated with inferior survival rates and increased treatment‐related toxicities. This pilot study sought to determine if a dietary intervention is feasible and minimizes weight gain during the initial phases of treatment for ALL. Methods Participants were recruited from four institutions, fluent in English or Spanish, between 5 and 21 years old, and enrolled within 3 days of starting induction therapy. Participants were counseled for 6 months to follow a low glycemic diet. Dietary and anthropometric data were collected at diagnosis, end of induction, and end of month 6 (NCT03157323). Results Twenty‐three of 28 participants (82.1%) were evaluable and included in the analysis. Dietary changes targeted by the nutrition intervention were successful; sugar intake declined (P = .003), whereas vegetable intake increased (P = .033). The majority of participants were able to adhere to the dietary principles prescribed: ≥70.0% reduced glycemic load and ≥60.0% increased fiber intake and decreased sugar intake. Importantly, we did not observe an increase in body mass index z‐score during induction or over the 6‐month intervention period. Most families found the nutrition intervention easy to follow (60%) and affordable (95%) despite simultaneous initiation of treatment for ALL. Conclusions A 6‐month nutrition intervention initiated during the initial phase of treatment for childhood ALL is feasible and may prevent weight gain. Our preliminary findings need to be confirmed in a larger clinical trial.

Improvement of Diet after an Early Nutritional Intervention in Pediatric Oncology

“…Other nutritional interventions in pediatric oncology have reported improvements in specific aspects of diet over time. Among them, in a multicenter pilot study implementing a nutrition intervention program shortly after a pediatric cancer diagnosis, the authors found an increase in the mean intakes of proteins and vegetables and a decrease in added sugar consumption when the final and initial assessments were compared [ 46 ]. Similar to our results, variations in caloric intakes were observed after the induction phase but did not persist over time.…”

“…Some authors have emphasized the difficulty of reversing unhealthy eating behaviors acquired during treatment [ 43 ], and several suggested implementing screening and intervention protocols at diagnosis and throughout treatment [ 44 , 45 ]. Despite these recommendations and the potential impact of diet during and after pediatric cancer, few nutrition interventions have been deployed with this population, and only one initiated early after diagnosis has been documented [ 46 ]. We have previously described the feasibility of an early nutrition intervention for children and adolescents undergoing cancer treatment [ 47 ].…”

Needs, Barriers and Facilitators of Adolescents Participating in a Lifestyle Promotion Program in Oncology: Stakeholders, Adolescents and Parents’ Perspective

“…To our knowledge, the only one published consists of an 8-module Facebook-based educational intervention for adolescents treated for cancer [ 52 ]. Otherwise, all health promotion interventions for adolescents implemented during cancer treatments included children of all ages or young adults [ 53 , 54 , 55 , 56 , 57 ].…”

Preventing weight gain in children with acute lymphoblastic leukemia by early nutritional intervention

“…6 To our knowledge, the study by Walters et al is the first nutritional intervention study undertaken during the induction phase of pediatric ALL therapy. 1 This multi-institutional study was conducted in person or via telemedicine in English or Spanish and offered nutritional counseling and educational materials adapted to the diet preferences of the ethnically and socioeconomically diverse population. Participants represented all four categories of body mass index (BMI) at baseline, with approximately 30% being overweight or obese.…”

“…In this issue, Walters et al report the results of a pilot study examining the feasibility and impact on weight gain of a nutritional intervention that was initiated during induction and continued through the first 6 months of therapy for acute lymphoblastic leukemia (ALL). 1 Although the survival rate of pediatric ALL is greater than 90% in high-income countries, 2 children with ALL still experience disease-related and treatment-related toxicities that negatively affect their quality of life.…”