Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: children and adolescents

Abstract

The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Children and Adolescents was developed by dietitians, physicians, and pediatric hematologists from 10 Brazilian reference centers in hematopoietic stem cell transplantation. The aim was to emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to patient´s nutritional assessment. This consensus is intended to improve and standardize nutrition therapy during hematopoietic stem cell transplantation. The consensus was approved by the Brazilian Society of Bone Marrow Transplantation.

Nutrition management of pediatric patients undergoing hematopoietic stem cell transplantation: Guidelines, gaps, and research

“…68,69 Acute GVHD typically involves skin, gastrointestinal tract, and/or liver, whereas chronic GVHD commonly impacts kin, liver, mouth, eyes, lungs, genitals, and musculoskeletal system. 16,61 Common symptoms of both acute and chronic GVHD in the gastrointestinal tract include nausea, vomiting, anorexia, diarrhea, abdominal pain, and food intolerance. 16,18 These symptoms should be monitored and managed by registered dietitians to prevent the possibility of malnutrition, significant weight loss, inadequate intake, and malabsorption.…”

“…16 Particularly, excessive gastrointestinal impairment and voluminous diarrhea may be an indication for implementation of PN. 61 Although universal consensus guidelines for nutrition management of GVHD do not exist, most institutions develop protocols for GVHD diets based on their own regional dietary practices. Continued follow-up and individualization of the diet is needed to ensure patients are receiving adequate nutrients tolerating dietary changes.…”

“…In general, patients undergoing chemotherapy and/or radiation may suffer from nausea, vomiting, diarrhea, mucositis, loss of appetite, and altered taste. 16,18,61…”

“…Patients undergoing HSCT experience depleted microbial diversity and temporary dysbiosis in its ecosystem resulting from conditioning regimens to antibiotic use. 61,73 Disruption of the microbiome plays a role in severity of diarrhea, acute GVHD, and increased incidence of bacteremia and infection in HSCT patients. 61,74,75 Low microbial diversity was found to be independently associated with overall survival, where one study in pediatric HSCT patients showed a threefold risk of death in those with low microbial diversity compared to those with higher microbial diversity.…”

“…61,73 Disruption of the microbiome plays a role in severity of diarrhea, acute GVHD, and increased incidence of bacteremia and infection in HSCT patients. 61,74,75 Low microbial diversity was found to be independently associated with overall survival, where one study in pediatric HSCT patients showed a threefold risk of death in those with low microbial diversity compared to those with higher microbial diversity. Estimated transplant mortality in patients with low microbial diversity was 53% compared to 9% in the high diversity group.…”